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

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

Background

Schwartz Center Rounds®(Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.

Objectives

How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.

Design

(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).

Setting

(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).

Participants

(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.

Results

(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.

Limitations

Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.

Conclusion

Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.

Future work

The adaptation of Rounds to new contexts and to increase reach needs evaluation.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The importance, impact and influence of group clinical supervision for graduate entry nursing students

This paper will report on an evaluation of group clinical supervision (CS) facilitated for graduate entry nursing (GEN) students whilst on clinical placement. The literature suggests educational forums which enable GEN students to engage in critical dialogue, promote reflective practice and ongoing support are an essential element of GEN curricula. The model of supervision employed was informed by Proctor's three function interactive CS model and Inskipp and Proctor's Supervision Alliance. Both emphasise the normative, formative and restorative functions of CS as task areas within an overarching humanistic supervisory approach. The three-function model informed the design of a questionnaire which intended to measure their importance, impact and influence through both structured and open-ended questions. Findings suggest the restorative function of supervision is most valued and is facilitated in an environment where humanistic principles of non-judgement, empathy and trust are clearly present. Also the opportunity to learn from others, consider alternative perspectives and question personal assumptions regarding capability and confidence are a priority for this student group. It is suggested that the restorative function of CS should be prioritised within future developments and models which view this function as a key purpose of CS should be explored.

Phenomenography: A methodology for information literacy research

The qualitative methodology phenomenography has been successfully used to determine the range of information literacy experiences of defined groups and professions. Phenomenographic method is believed to yield research findings which give a richer and more accurate picture of what information literacy means in practical terms. The archetypal definitions of the limited but interrelated experiences of information literacy that a phenomenographic study provides have been used as a basis of evidence-based information literacy educational interventions (Andretta, 2007). What are the epistemological ideas behind phenomenography and what are the data collection and analysis procedures based on its philosophical underpinnings? The key principles as described in the literature are discussed in this paper, beginning with the early work of Marton (1986). The use of phenomenography to research information literacy experience began with Christine Bruce’s (1997) seminal work. The value of the work of Bruce and her followers have been recently recognized by ACRL (2014).

Group supervision to strengthen nurses in their preceptor role in the bachelor nursing education--perceptions before and after participation

BACKGROUND

A collaborative project was carried out at four bachelor nursing colleges in Sweden and Norway, to support preceptors in the clinical fields by means of group supervision. The aim of this study was to investigate the preceptors' views on their own ability and satisfaction in the role before and after taking part in group supervision during one year and to describe their perception of the supervision model used.

METHOD

Forty-five preceptors participated in the study. Baseline and endpoint questionnaires were used for data collection.

RESULTS

Before taking part in group supervision most preceptors expressed that they were content with their ability and knowledge with regards to the preceptor role. Despite this most of them considered that the participation had increased their ability to supervise students, and more than half of them considered that it also had promoted to their personal development. At the end of the project a majority of them had positive experiences of group supervision. Most of the structure and climate factors in the supervision model were considered important and almost all were highly realised.

CONCLUSION

The study showed that group supervision could be a valuable tool to provide support to clinical preceptors in bachelor nursing education.

Evaluation of the Manchester clinical supervision scale: Norwegian and Swedish versions

AIM

To develop Norwegian and Swedish versions of the Manchester Clinical Supervision Scale (MCSS) and to test and verify its hypothesized seven-factor structural model.

BACKGROUND

Nurse managers are responsible for upholding and ensuring quality of care as well as for maintaining staff competence, thus safeguarding the standard of care.

METHODS

The research process included a translation-back-translation procedure with monolingual and bilingual tests in addition to psychometric evaluation. The sample consisted of 150 student and registered nurses (RNs) from Norway and Sweden, and confirmatory factor analysis was performed.

RESULTS

The translated versions did not exhibit satisfactory validity and reliability. The confirmatory factor analysis failed to show a good model fit. Low α-values were revealed except for factors 1, 2, 3 and 7. The most important factors of the MCSS were Trust/Rapport, Supervisor advice/Support, Improved care/Skills and Reflection.

CONCLUSION

Translation of an instrument for cross-cultural nursing research is important, although there are methodological limitations associated with construct validity. IMPLICATION FOR NURSE MANAGERS: Instruments for the evaluation of nursing care are necessary in order to formulate strategies at a managerial level. Nurse managers who encourage nurses to attend supervision promote professional development and enhance patient safety.

Team Clinical Supervision in Acute Hospital Wards

Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- ( n = 36) and postintervention ( n = 27), and focus groups ( n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.

Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies

AIM

To describe and explore Advanced Practice Nurses' clinical competencies and how these are expressed in clinical practice.

BACKGROUND

Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined.

THEORETICAL FRAMEWORK

The study's theoretical framework emanates from Aristotle's three-dimensional view of knowledge that is epistêmê, technê, and phronesis.

METHODS

Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis.

FINDINGS

Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients' caring needs and nursing care activities, (B) the caring relationship, (C) multi-professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture.

CONCLUSION

Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs' scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being.

Psychiatric hospital nursing staff's experiences of participating in group-based clinical supervision: an interview study

Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in group-based supervision and identifying psychosocial reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses.

Establishing clinical supervision in acute mental health inpatient units: acknowledging the challenges

After decades of discussion about clinical supervision and mental health nursing, the reality is that many acute mental health inpatient settings continue to struggle with the notion of clinical supervision and the implementation process. In this article we delineate the key elements of clinical supervision, explore practical and dynamic difficulties associated with clinical supervision and question whether too much is being asked of this one process, especially in acute inpatient settings. For many mental health nurses, existing practices offer many of the purported benefits of clinical supervision. Ultimately, unless clinical supervision is better understood and implemented effectively, it is unlikely to meet expectations. Clinical supervision should ultimately be defined by the nurses participating in it. This article contributes to current discussions regarding the purpose of clinical supervision, the realities of its implementation, and in particular considers the role of clinical supervision relative to existing professional support opportunities.

Empirical studies of clinical supervision in psychiatric nursing: A systematic literature review and methodological critique

The objective of this paper was to systematically review and critically evaluate all English language research papers reporting empirical studies of clinical supervision in psychiatric nursing. The first part of the search strategy was a combination of brief and building block strategies in the PubMed, CINAHL, and PsycINFO databases. The second part was a citation pearl growing strategy with reviews of 179 reference lists. In total, the search strategy demonstrated a low level of precision and a high level of recall. Thirty four articles met the criteria of the review and were systematically evaluated using three checklists. The findings were summarized by using a new checklist with nine overall questions regarding the studies' design, methods, findings, and limitations. The studies were categorized as: (i) effect studies; (ii) survey studies; (iii) interview studies; and (iv) case studies. In general, the studies were relatively small scale; they used relatively new and basic methods for data collection and analysis, and rarely included sufficient strategies for identifying confounding factors or how the researchers' preconceptions influenced the analyses. Empirical research of clinical supervision in psychiatric nursing was characterized by a basic lack of agreement about which models and instruments to use. Challenges and recommendations for future research are discussed. Clinical supervision in psychiatric nursing was commonly perceived as a good thing, but there was limited empirical evidence supporting this claim.

Wicked spell or magic bullet? A review of the clinical supervision literature 2001-2007

Clinical supervision has become an established part of nursing. Implemented in various different ways it has attracted attention from the research, educator and practice communities. The literature reported and analysed in this paper describes work that may benefit professional practice but there continue to be questions about application and method. Two new messages arise from the literature. The first underscores the responsibility of health care organisations to sustain and develop clinical supervision and the second points to the potential benefit that clinical supervision may have on patient outcomes.

Achieving meaningful learning in health information management students: the importance of professional experience

Learning is a complex process, not merely a transfer of information from teacher to student. for learning to be meaningful, students need to adopt a deep approach, and in the case of vocational students, to be given the opportunity to learn experientially. Health information management is a practice profession for which students are educated through theory at university and professional experience in the workplace. This article discusses how, through the process of experiential learning, professional experience can promote reflective thinking and thus deep learning, that is, the ability to integrate theory and practice, as well as professional and personal development in health information management students.

Group-format clinical supervision for hospice nurses

This paper discusses the aspects of a small research study, which used mixed research methods. The study concerned group-format supervision as a means of helping five hospice nurses, four women and one man, discuss their work experiences. An aim of the study was to understand something of the professional work of hospice nurses and how they might best be supported. Ethical considerations and some benefits derived by group members from clinical supervision are summarized in the context. The research method entailed 12 sessions of group-format clinical supervision. The discussion explores the forming, management and dynamics of a small clinical supervision group. Hospice work is emotionally demanding of nurses. Nurses throughout this small study thought over issues concerning serious illness, death and bereavement, as well as working together as a supervision group. Group-format supervision is potentially helpful to nurses examining professional practice. However, group work can be as challenging to participants as it is helpful. The discussion concludes with an appraisal of the potential gains for nurses from clinical supervision in group-format. This paper proposes that supervision groups could help hospice nurses to identify and explore issues related to professional practice. Adequate preparation of nurses, organizational support and the competency of group facilitators should be considered critical to safe and effective management of professional groups.

Are supervisors using theoretical perspectives in their work? A descriptive survey among Swedish-approved clinical supervisors

AIM

The aim of the study was to explore the theoretical perspectives in use by approved clinical nursing supervisors in Sweden.

BACKGROUND

For the time being, we know little of the theoretical perspectives in use on a daily basis by the clinical nursing supervisors in Sweden.

METHODS

A questionnaire (n = 49) and follow-up telephone interviews (n = 14) were used. Data analysis was made by descriptive statistics and qualitative content analysis.

RESULTS

The result from the questionnaire showed that the supervisors often used and combined different theoretical perspectives with origins in nursing, education and psychology. Surprisingly, one-fourth of the respondents did not state any nursing theoretical perspective in use during clinical nursing supervision. The result from the interviews revealed that the theory of Katie Eriksson (1987) was the most commonly used nursing perspective.

CONCLUSION

As the overall aim for clinical nursing supervision is to improve nursing for the patient/family, the supervisor's competence in nursing is essential. Given this fact, and that only three-quarters of the approved clinical nursing supervisors stated a use of theoretical nursing perspective when supervising, there is obviously a need for further investigations in this area. In addition, there is also a need for approved Swedish clinical nursing supervisors, to further become aware of the theoretical perspective in use that supports their clinical nursing supervision. Clinical nursing supervision is a multifaceted activity that needs to be supported by different nursing theoretical perspectives including physical, emotional, intellectual, spiritual as well as socio-cultural aspects.

Group clinical supervision for mental health nursing students

Clinical supervision is recognized as important for developing safe professional practice in nursing. Although attention has been given to the development of training and education in clinical supervision for registered nurses, less discussion exists regarding these issues for pre-registration mental health nursing student to the theory and practice of group clinical supervision. In particular, this article raises awareness and promotes discussion of the practical issues involved in such an initiative.

Multidisciplinary attitudinal positions regarding clinical supervision: a cross-sectional study

AIM

The aim of this study was to describe multidisciplinary attitudes towards/about Clinical Supervision.

BACKGROUND

Clinical Supervision continues to be a matter of high interest for nurses and other health care disciplines. Despite the existence of a body of a substantive literature, gaps in our knowledge base remain.

DESIGN

Data was collected using a form composed of 17 statements. A total sample of 74 participants completed the form and rank-ordered the statements. The sample was comprised of a mix of eight different disciplines: Registered Nurses (hospital based), Chiropodists, Occupational Therapists, Learning Disability Nurses, Registered Nurses (community based), Registered Mental Health Nurses, Health Visitors and Physiotherapists. Data were analyzed by descriptive and non-parametric statistics.

RESULTS

The respondents' agreement was high concerning the rankings of the item (11) ''Confidentiality is assured and agreed''. Almost all respondents ranked this item as the most important characteristic for group supervision. The respondents shared almost a total agreement concerning the item (17) ''The supervisor should be a manager''. This was ranked as the least important characteristic for group supervision.

CONCLUSION

The importance of having a clinical supervisory relationship that remains separate from administrative/managerial supervision and one where confidentiality is assured was highlighted by this study. Furthermore, the attitudes were not restricted to one professional or disciplinary group. The effective support system of clinical supervision should therefore not be diluted by awkward and unnecessary amalgamations with administrative/managerial supervision.

Fostering a culture of support in mental health settings: alternatives to traditional models of clinical supervision

Clinical supervision [CS] for mental health nurses in inpatient settings in Sydney, Australia, is virtually nonexistent despite over a decade of discussion regarding its benefits to staff, patients, and organisations. Whilst there is general agreement about the merit of CS, its ad-hoc implementation and the use of models that do not correspond to the realities of the environment have led to its adoption being somewhat half-hearted. It is unsurprising then that there is an absence of achievable policy regarding CS making its integration into modern inpatient units even harder to attain. In this paper, we outline some pragmatic issues concerning CS and advocate for facility-specific professional development and support processes that incorporate succession planning opportunities. This we believe has the potential to promote professional behaviour, continuous learning and development, cohesive teamwork, and ultimately a change in culture regarding CS.

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.

Efficacy of clinical supervision: influence on job satisfaction, burnout and quality of care

AIM

This paper reports a study to determine how supervisees' backgrounds and surrounding infrastructure predict the efficacy of clinical supervision among Finnish nursing staff, their job satisfaction, levels of burnout and perceptions of the quality of care.

BACKGROUND

Several studies have described the effects of clinical supervision, but few have focused on evaluating it. Until recently, no studies have examined how clinical supervision evaluations are related to supervisees' backgrounds, surrounding infrastructure or respondents' levels of burnout, job satisfaction and perceptions of the quality of care.

METHODS

The survey involved supervisees completing a range of standardized and validated evaluation measures. The respondents were identified from 12 regional, central and university hospitals across Finland (n = 799). The data collection took place from October 2000 to February 2001.

FINDINGS

The evaluations varied statistically significantly and were associated with statistically significant variations in the respondents' backgrounds. Clinical supervision infrastructure was also strongly related to evaluation scores. Supervisees' age, education, gender, employment status, area of specialty, working hours, work experience and experience as a supervisor were statistically significant predictors for evaluations of the efficacy of clinical supervision. These evaluations of clinical supervision were also found to predict the respondents' job satisfaction, levels of burnout and assessments of good nursing.

CONCLUSION

Nursing staff, especially those who have over 10 years' work experience, work in general care, have a nursing diploma, are non-tenured, work part-time and work 24-hour rotating shifts can benefit from clinical supervision. However, resources need to be invested in supervisor education and nursing staff need to be encouraged to start working in both supervisor and supervisee roles because of the positive effects on job satisfaction and quality of care.

A systematic review of evidence on the professional practice of the nurse and developing and sustaining a healthy work environment in healthcare

OBJECTIVES

The overall aim of this systematic review was to identify the best available evidence on the relationship between the knowledge, competencies and behaviours of nurses exhibiting professional practice in their workplace; and the development of a healthy work environment.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished studies written in the English language. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify optimal search terms. A second extensive search using all identified key words and index terms was then undertaken.

METHODOLOGICAL QUALITY

Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package.

RESULTS

Of the 4238 papers found in the search: 219 were selected for full paper retrieval; 19 of these papers were unable to be located; 200 full papers were assessed for methodological quality; 181 studies were excluded; and 19 were included in the review. Of these 19, four quantitative studies evaluated a professional nursing practice model and its impact on a variety of outcomes; five descriptive studies examined elements of nurses' professional practice and the impact these elements had on specified outcomes; and 10 qualitative papers examined varying behaviours, competencies and knowledge levels of nurses. Various methods were used, such as focus groups and open-ended interviews. Overall, the evidence suggests that professional practice has a positive impact on the work environment in terms of nurses' role satisfaction and patient outcomes. The evidence is, however, equivocal in many areas and the impact of the professional practice of the nurse requires further investigation.

CONCLUSION

The results of the review suggest a number of recommendations for practice and research on creating a healthy work environment.

How the spiritual dimension is addressed in psychiatric patient-nurse relationships

AIM

This paper reports a study describing nurses' conceptions of how the spiritual dimension is addressed in psychiatric patient-nurse relationships.

BACKGROUND

In psychiatric care, it is essential that patient-nurse relationships be built on a holistic view. In this context, nursing research shows that there is a lack of integration of the spiritual dimension.

METHOD

Twelve strategically selected psychiatric nurses were interviewed and analysed using a phenomenographic approach. The data were collected in 2003.

FINDINGS

The main findings were three descriptive categories: being a good carer, recognizing the spiritual dimension, and regarding the spiritual dimension as difficult to capture in patient-nurse relationships. The first descriptive category shows that nurses deal with spirituality by behaving as good carers. Those included in the second descriptive category reveal nurses who are aware of patients' spiritual needs and who deal with these needs in different ways. The third descriptive category consists of conceptions revealing lack of knowledge of patients' spiritual needs, both in abstract and real terms.

CONCLUSIONS

Further research is needed to explore how patients describe their own spiritual needs, and how nursing staff can learn to be aware of and understand their own spirituality, thus enabling them to detect, discuss, clarify and deal with the concept of spirituality in patient-nurse relationships.

Nursing students’ perception of group supervision during clinical training

AIM

The aim of this study was to investigate nursing students' perception of and satisfaction with clinical group supervision based on a special model, used in nursing training.

BACKGROUND

Long-standing efforts have been made to create supervision models in nursing training that promote personal and professional development and prepare nursing students to cope with the complex and demanding situations they will face as registered nurses.

METHODS

Data were collected from nursing students (n = 43) during their clinical training by means of two questionnaires. Most questions were concerned with the importance of factors involved in the contract and the students' experiences of how these factors were covered during the clinical group supervision.

FINDINGS

The findings showed that, before starting the supervision programme, most all the students expressed positive attitudes towards group supervision, but 25% had negative expectations as well. At the end of the programme all students thought that group supervision had been an important support to them during their training and almost everyone wanted to participate in group supervision in the future as registered nurses. The findings showed that both the structure and the climate were important for the success of the group supervision.

RELEVANCE TO CLINICAL PRACTICE

The findings will strengthen the model and confirm its usefulness in clinical training for nursing students. Using this supervision model, which includes reflection about feelings, thoughts and actions, the students will be well prepared for demanded situations in their future role as a registered nurse. A replication of this study addressed to trained nurses would be valuable.

Factors influencing nurse supervisor competence: a critical incident analysis study

AIM

The aim of the study was to identify factors related to critical incidents that influence the competence of nurse supervisors.

BACKGROUND

Nurse supervisors require considerable competence in order to help supervisees to reflect on their clinical work and to interpret the needs of the patient.

METHOD

A qualitative approach involving the critical incident technique was used. Critical incidents were collected by means of self-reports from 25 nurse supervisors.

FINDINGS

Two main areas emerged: a professional and a personal stance. The professional stance described the nurse supervisors' awareness of the importance of creating a secure learning environment and facilitating reflection. The supervisors structured the material and created awareness of fundamental nursing values. The second main area, personal stance, described the nurse supervisors' behaviour when they gave the participating nurses the opportunity to work through the experiences gained in the daily provision of nursing care. Although they experienced lack of self-assurance during the supervision session, they also expressed security regarding their own performance as nurse supervisors.

CONCLUSIONS

Nurse supervisors need to include more nursing theory and focus on the nursing process as well as being aware of their own shortcomings and resources. One way for the supervisor to scrutinize his/her actions is to discuss and examine them with a more experienced nurse supervisor colleague.

Clinical supervision, burnout, and job satisfaction among mental health and psychiatric nurses in Finland

This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.

The cultural realities of clinical supervision in an acute inpatient mental health setting

In this paper, the cultural realities of clinical supervision (CS) in acute inpatient mental health settings are explored using an ethnographic approach. Findings suggest that there is a verbal acceptance of CS by mental health nurses but a cultural belief that it has limited experiential value and, thus, a cautious attitude towards its adoption is in practice. This may, in part, be attributable to many nurses believing that they are already undertaking CS, although the informal supervision described does not fit with established definitions of formal supervision. The language used by nurses demonstrates an understanding and appreciation of the benefits of clinical supervision. However, the belief that existing structures inherent to nursing practice already convey these benefits may contribute to the culture of passive resistance to clinical supervision revealed by the findings. This study contributes to current discussions regarding the purpose of CS, the realities of its implementation, and its role relative to existing professional support opportunities.

First-line managers' views of the long-term effects of clinical supervision: how does clinical supervision support and develop leadership in health care?

There have recently been several organizational changes that have challenged nursing managers in the Finnish health care system. First-line managers need support in their work because of organizational changes and scarce economic resources. One of these supportive measures is clinical supervision. A group of first-line managers in a Finnish University hospital participated in a 2-year clinical supervision intervention in 1999-2000. The managers' perceptions of the clinical supervision were followed up twice during the intervention and 1 year after (2001). The aim of this study is to describe how the first-line managers saw the future effects of the clinical supervision intervention 1 year after its termination. At the beginning of the intervention, the number of participating nursing managers was 32. The number of respondents in this study 1 year (2001) after the clinical supervision was 11. Data was collected using empathy-based stories, which involved writing short essays. The respondents received orientation and a script to assist them in the writing of essays. The stories were analysed qualitatively by categorizing the responses by themes. The managers deemed that clinical supervision had, in the 3-year time frame, positive long-term effects on their leadership and communication skills, the desire for self-development, self-knowledge and coping. Managers believed that in the long run, clinical supervision would provide them with a broader perspective on work and would enhance the use of clinical supervision as a supportive measure among co-workers. First-line managers expect clinical supervision to have long-term positive effects on their work and coping. Empathy-based stories, as a method, were found suited to studies, which aim to obtaining future-oriented knowledge.

Nursing home care: changes after supervision

BACKGROUND

An intervention project was conducted in three nursing home wards in Sweden. Most patients had severe dementia. The intervention consisted of supervision for individualized and documented nursing care, based on multidimensional assessment.

AIM

To illuminate changes in carers' approach after the intervention.

METHODS

Several data collections were conducted across the intervention and consisted of nursing documentation, patient life stories as told by carers, video recorded interactions, stimulated recall interviews and a questionnaire. Both quantitative and qualitative methods were used in the analyses.

FINDINGS

The findings from the different methods mirrored each other and added to the credibility of the intervention. Communicated knowledge about patients improved in nursing documentation and also as told by carers. Carers were differently skilled in managing the complexity of nursing care situations before as well as after the intervention, but the intervention contributed to developing carers in 'confirming nursing care'. They also improved in their ability to verbalize reflections about their everyday life with patients with dementia.

CONCLUSION

Supervision made it possible for carers to share their lived experiences about their day-to-day life with patients, which could promote personal and professional development and thus improve care quality. It also appeared that a detailed assessment tool used as part of the nursing process contributed to seeing a patient as a real person behind a dementia surface.

Some benefits experienced by hospice nurses from group clinical supervision

A small clinical supervision group consisting of five hospice nurses met together in their workplace 1 h weekly for 12 weeks. Issues concerning professional practice were examined with the help of a researcher (A.J.) who acted as facilitator. At the end of the group's life A.J. asked all nurses to complete a questionnaire related to the workplace and 12 identified helpful factors. Two weeks later the hospice nurses were interviewed in group format and asked to consider the reasons for their choice of answers. The data revealed that collectively--interpersonal learning (output), identification, catharsis, family re-enactment, group cohesiveness and self-understanding were experienced by the hospice nurses as the most helpful factors to the group. Existential factors, guidance, universality, interpersonal learning (input), instillation of hope and altruism were identified as less important. Variations in individual responses showed different ways in which a group might meet the needs of its members. The study concludes with the suggestion that work discussion groups can offer nurses the means to calm, regulate and plan their interactions with themselves and others. Clinical supervision is an effective format for exploring issues concerning professional practice, allowing nurses to: learn from each other, offer support, recognize how others see and esteem them as fellow workers, and moderate concerns and anxiety related to their work. Group work is likely to raise anxiety in all participants, however, and preparation and support are required for the group facilitator. Carefully chosen membership is also considered important to the safety of members and successes of the group.