Multiprofessional clinical supervision: challenges for mental health nurses

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.

The Role of Supervision in Preventing Burnout among Professionals Working with People in Difficulty

The value of people in their various dimensions is a priority in the postmodern era. In this respect, programs are being implemented for disadvantaged social categories to compensate for differences, reduce discrepancies, and integrate marginalized people into society. This, however, is not easy, and the work of professionals with people in difficulty is frequently difficult, consuming multiple resources and, sometimes, leading to burnout. The professions involved in the recovery work of people in difficulty provide social, medical, psychological, and spiritual assistance services in order to restore or increase the well-being of disadvantaged people or social groups. This study presents an analysis of burnout among social workers and clerics and the effect of supervision on burnout. In support of this, a sociological survey (n = 502) was conducted on a convenience sample of Romanian social workers and clerics in June 2018. The main conclusion of the study is that supervising professionals working with people in difficulty significantly reduces the risk of burnout.

Clinical supervisors' experiences of using an interprofessional clinical supervision model in an acute care setting

Often, students converge on the acute healthcare setting in professional silos, focusing solely on key learning objectives specific to their profession. The use of an Interprofessional Clinical Supervision (IPCS) model may enable students from medicine, nursing, pharmacy, and allied health to develop profession-specific skills, provide opportunities to improve communication skills within an interprofessional team and enhance student understanding of other health professionals' contributions to care delivery. Clinical supervision of these students within an IPCS model presents a number of logistical and interprofessional challenges. Through the use of two semi-structured group interviews, we sought to understand interprofessional clinical supervisors' (n = 4) perspective of implementing the IPCS model. Thematic analysis revealed emerging themes of planning, interprofessional supervisor utilization, role clarity and perceived professional limitations from the data. This study found that the IPCS model can provide an innovative alternative to traditional profession specific supervision models and interprofessional education activities, particularly given the climate of increasing student numbers and reduced resources.

A systematic review of clinical supervision evaluation studies in nursing

According to the international, extant literature published during the last 20 years or so, clinical supervision (CS) in nursing is now a reasonably common phenomenon. Nevertheless, what appears to be noticeably 'thin on the ground' in this body of literature are empirical evaluations of CS, especially those pertaining to client outcomes. Accordingly, the authors undertook a systematic review of empirical evaluations of CS in nursing to determine the state of the science. Adopting the approach documented by Stroup et al. (JAMA, 283, 2000, 2008), the authors searched for reports of evaluation studies of CS in nursing - published during the years 1995 to 2015. Keywords for the search were 'clinical supervision', 'evaluation', 'efficacy', 'nursing', and combinations of these keywords. Electronic databases used were CINAHL, MEDLINE, PsychLIT, and the British Nursing Index. The research evidence from twenty-eight (28) studies reviewed is presented, outlining the main findings with an overview of each study presented. The following broad themes were identified and are each discussed in the study: narrative/anecdotal accounts of positive outcomes for clinical supervision, narrative/anecdotal accounts of negative outcomes for clinical supervision, empirical positive outcomes reported by supervisee, and empirical findings showing no effect by supervisee.

The experience of clinical supervision for nurses and healthcare assistants in a secure adolescent service: Affecting service improvement

WHAT IS KNOWN ON THE SUBJECT?: Regular and effective clinical supervision for mental health nurses and healthcare assistants (HCAs) is an important tool in helping to reduce stress and burnout, and in ensuring safe, effective and high-quality mental health care. Previous studies of clinical supervision within secure mental health environments have found both a low availability of clinical supervision, and a low level of staff acceptance of its value, particularly for HCAs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In previous studies, the understanding shown by HCAs and nurses around the benefits of clinical supervision may have been limited by the methods used. This study was specifically designed to help them best express their views. In contrast to previous studies, both nurses and HCAs showed a good understanding of the function and value of clinical supervision. Significant improvements in the experience of, and access to, clinical supervision for nurses and HCAs working in secure mental health services may be achieved by raising staff awareness, demonstrating organizational support and increasing monitoring of clinical supervision. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations should consider reviewing their approach to supervision to include raising staff awareness, multidisciplinary supervision, group supervision, and recording and tracking of supervision rates. Organizations should be mindful of the need to provide effective clinical supervision to HCAs as well as nurses.

ABSTRACT

Introduction Studies have found a low availability and appreciation of clinical supervision, especially for healthcare assistants (HCAs). Qualitative research is needed to further understand this. Aims Increase understanding of nurses' and HCAs' experiences of, and access to, clinical supervision. Identify nurses' and HCAs' perceptions of the value and function of clinical supervision. Assess how interventions affect staff's experiences of clinical supervision. Methods In 2013, HCAs and nurses in a secure adolescent service were surveyed about clinical supervision. Forty-nine HCAs and 20 nurses responded. In 2014, interventions to facilitate supervision were introduced. In 2016, the study was repeated. Forty HCAs and 30 nurses responded. Responses were analysed using a mixed methods approach. Results Significantly more HCAs found supervision to be a positive experience in 2016, and both nurses and HCAs reported significantly fewer challenges in accessing supervision. HCAs and nurses understood the value of clinical supervision. Discussion Significant improvements in the experience of clinical supervision were achieved following increased staff awareness, multidisciplinary and group supervision, and recording supervision rates. HCAs and nurses understood the consequences of inadequate supervision. Implications for practice Organizations could adopt the interventions to facilitate clinical supervision. Supervision should not be overlooked for HCAs.

Nursing and health-care assistant experience of supervision in a medium secure psychiatric service for women: implications for service development

In secure psychiatric services where the potential for 'burnout' by nurses is high, clinical supervision is viewed as a key to reflective practice to support staff in stressful working environments. Barriers to the uptake of clinical supervision in such service settings are personal and organizational. The study was prompted by the need to evaluate the effectiveness of supervision for registered nurses and health-care assistants (HCAs) and a desire to use survey findings to improve the quality and uptake of supervision. The study examined the perceived benefits, the best practice elements and the practical aspects of clinical supervision including how to improve practice. An approximate uptake of clinical supervision by 50% of staff confirmed previous findings; that HCAs were significantly less likely to engage in supervision and less likely to perceive benefit from it. Initiatives to address the training and managerial obstacles to the provision of formal supervision are described.

Psychiatric nursing staff members' reflections on participating in group-based clinical supervision: a semistructured interview study

This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very limited impact on their clinical practice. Neither management nor the staff effectively prioritized clinical supervision, which added to a downward spiral where low levels of participation undermined the potential benefits of clinical supervision. The respondents embraced and used alternative forums for getting emotional support among peers, but maintained that formalized supervision was the only forum for reflection that could solve the most difficult situations.

Becoming a psychiatric/mental health nurse in the UK: a qualitative study exploring processes of identity formation

Identity studies are well established across the social science literature with mental health nursing beginning to offer evidenced insights into what may, or may not, constitute key identity performances. For mental health nursing these performances remain contested, both from within the profession and from international contexts that favour generic constructions of mental health. This paper offers findings from a qualitative study that focused upon the process of how mental health nursing identity development is influenced, rather than what that identity may or may not be. These findings highlight that mental health nurses (MHNs) not only form their identity around service user centred education and training, but that many also use the education as a means to leave the profession. Through highlighting the impact of informal education (i.e., through work), formal education, and training upon the formation of mental health nursing identity, nurses are potentially alerted to the importance of clinically focussed mental health being prominent within curricula, rewarding mental health nursing skills specialisation, and the importance of the role of the service user in mental health nurse education and, hence, identity formation.

Interprofessional mentoring: enhancing students' clinical learning

Interprofessional (IP) collaboration is recognized as critical for patient-centred care. The clinical setting is an ideal environment for students to learn the competencies required to effectively work with providers from other professions. To enhance traditional clinical placements, we propose an IP mentoring approach, defined as learning that takes place between providers and students who are from different disciplines or health professions. In IP mentoring, students have primary relationships with their preceptors, but also have interactions with providers from other professions. We implemented IP mentoring with the support of two faculties of nursing in Alberta, Canada who provided an IP clinical focus for interested fourth year students. We emphasized to providers and students that there are no prescribed interactions that comprise IP mentoring; experiences between providers and students are context-specific and often informal. Through our evaluation we demonstrated that in IP mentoring, provider commitment was important, students engaged in IP activities of varying complexity, and students learned about roles of other professions and how to work together to provide patient-centred care. IP mentoring is an effective learning strategy to enhance students' knowledge and skills in IP collaboration without radical changes to the structure of the placements or to the educational curricula.

Self-harm: what's the problem? A literature review of the factors affecting attitudes towards self-harm

People who have experienced self-harm report dissatisfaction with the care provided by statutory services. This review provides a critical exploration of the evidence examining the attitudes of healthcare professionals across both mental health and medical settings towards people who self-harm. It also explored in detail service users perceptions of care. A literature search conducted via electronic databases and cross-matching reference lists produced 19 papers that met the inclusion criteria. A thematic analysis of the literature indicated six key areas which contributed to the development of attitudes defined as positive or negative towards people who self-harm. Negative attitudes and experiences of care were associated with lack of education and training, the impact of differences in perceptions of health professionals' role and the influence of clinical culture as well as how self-harm was perceived as a health need. More positive attitudes were associated with a greater understanding of experiences of self-harm and improved training. However, the nature of care reported by service users indicates that there are still significant improvements needed to the attitudes in health settings to ensure they receive a high-quality service.

Individual and workplace factors that influence psychiatric nursing staff's participation in clinical supervision: a survey study and prospective longitudinal registration

This paper reports findings from a survey of 239 psychiatric nursing staff. This study aimed to investigate how often psychiatric nursing staff participates in clinical supervision and any possible associations among individual and workplace factors in relation to participation. The survey findings are followed by a prospective longitudinal registration of participants in clinical supervision. The registration revealed that participation varies considerably and large numbers of the staff may not participate in clinical supervision at all. Characteristics of the workplace, including organisational location, work shift, and work-environmental factors, are related to participation and, consequently, may affect the outcome of clinical supervision.

Innovations on a shoestring: a study of a collaborative community-based Aboriginal mental health service model in rural Canada

Background

Collaborative, culturally safe services that integrate clinical approaches with traditional Aboriginal healing have been hailed as promising approaches to ameliorate the high rates of mental health problems in Aboriginal communities in Canada. Overcoming significant financial and human resources barriers, a mental health team in northern Ontario is beginning to realize this ideal. We studied the strategies, strengths and challenges related to collaborative Aboriginal mental health care.

Methods

A participatory action research approach was employed to evaluate the Knaw Chi Ge Win services and their place in the broader mental health system. Qualitative methods were used as the primary source of data collection and included document review, ethnographic interviews with 15 providers and 23 clients; and 3 focus groups with community workers and managers.

Results

The Knaw Chi Ge Win model is an innovative, community-based Aboriginal mental health care model that has led to various improvements in care in a challenging rural, high needs environment. Formal opportunities to share information, shared protocols and ongoing education support this model of collaborative care. Positive outcomes associated with this model include improved quality of care, cultural safety, and integration of traditional Aboriginal healing with clinical approaches. Ongoing challenges include chronic lack of resources, health information and the still cursory understanding of Aboriginal healing and outcomes.

Conclusions

This model can serve to inform collaborative care in other rural and Indigenous mental health systems. Further research into traditional Aboriginal approaches to mental health is needed to continue advances in collaborative practice in a clinical setting.

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.

Supervisor experiences of supervising nursing staff in the care of older people

AIM

To describe supervisors' experiences of supervising nursing staff who care for older people in order to develop an understanding of the opportunities and limitations involved in supervision.

BACKGROUND

Little is known of what group supervision of nursing staff means for the supervisor, particularly in regards to care of the old.

METHODS

A reflective life-world research approach, based upon phenomenological epistemonology was used. Two supervisors with 2 years experience of supervising nursing staff caring for older people were interviewed.

CONCLUSIONS

Results point to the need for support for supervisors in order to enable them to develop their supervisory abilities and skills.

IMPLICATIONS FOR NURSING MANAGEMENT

Support is of crucial importance for both the ability to supervise and the quality of supervision.

Implementation of clinical supervision in action: Part 3: the development of a model

Implementation has been observed to be crucial to the successful introduction of clinical supervision. Despite its importance, there is limited literature which articulates principles or process to guide it. The first and second parts of this three-part paper present findings of a qualitative exploration of the implementation of clinical supervision in a rural mental health service. The findings were discussed in light of the Driscoll model of implementation. While this model provided a valuable tool to interpret some aspects of the findings, its focus was primarily on the preimplementation stage, particularly in terms of assessing the workplace culture and the recognition of the pushing and resisting forces in relation to clinical supervision. This paper presents a new model of implementation with interrelated and dynamic stages. The model was developed in a rural mental health service context. An overview of this research-based model is presented in this paper.

Implementing clinical supervision: Part 1: laying the ground work

Australia, like other countries, is experiencing a crisis in the recruitment and retention of nurses. Clinical supervision has been suggested as a potential strategy to enhance retention. However, there is a paucity of literature regarding the successful implementation of clinical supervision. The aim of this study is to explore and evaluate ways of implementing clinical supervision as undertaken in a rural health-care organization in Victoria. Qualitative methodology was used including a documentation audit and individual interviews with the staff responsible for implementation. The findings demonstrate that the successful implementation had occurred in five interrelated stages. This paper, one in a series of three, focuses on the preimplementation phase leading up to initial implementation. The main themes identified during these stages were: organizational culture, exploring the possibilities, leadership and education and training which will be examined. These issues were essential in laying the foundation for the systematic introduction of clinical supervision.

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.

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.

An audit of clinical supervision in primary care

This article reports on an audit of clinical supervision in one primary care trust (PCT). Data were collected by telephone interviews with 44 respondents from a range of professions occupying different clinical and managerial grades in the organization. Clinical supervision was varied both in terms of its availability and management between different professional groups and teams reflecting, in part, differing levels of motivation towards supporting clinical supervision by individual practitioners and managers as well as a perceived lack of trust leadership. Respondents also reported several potential and actual benefits of clinical supervision, including the improvement and standardization of practice and the facilitation of learning and professional development, although there was no consensus regarding the most appropriate format (e.g. individual, group or team) or structure (e.g. uni-professional or multi-professional) for clinical supervision. It was widely agreed that the introduction of mechanisms for monitoring both the process and outcomes of supervision, greater protection of time allocated for supervision and more training opportunities to increase the skill and number of available supervisors were needed.

Team supervision in multiprofessional teams: team members' descriptions of the effects as highlighted by group interviews

The aim of the study was to describe the effects of team supervision in multiprofessional teams as perceived by team members. The literature describes team supervision as a way to develop collaboration in multiprofessional teams. However, little empirical research into the effects of team supervision is available. A research project was undertaken on five units of a university hospital between 1995 and 1998. Data were collected using group interviews with 62 interviewees and were analysed using qualitative content analysis. Team members' perceptions of the feeling of togetherness varied. Communication had become more open in the teams, but the frankness of expression varied: communication had generally become more tactful, whereas in one of the teams frankness offended some members. Team members had learned to know each other. This had improved mutual understanding, but also increased tension. Teams' working methods had changed. Joint decision making had developed, but conflicts had also emerged. Motivation for work had improved as a result of the awareness of shared problems. However, motivation had been lessened by frustration caused by slow progress in the team. Perceptions of the effects of team supervision in the multiprofessional teams varied by units and teams. The study showed that team supervision is a challenge to supervisors.

Expert supervisors' views of clinical supervision: a study of factors promoting and inhibiting the achievements of multiprofessional team supervision

BACKGROUND

Only a few studies are available of team supervision and its challenges to supervisors. A multiprofessional team supervision project was accomplished in 1995-1998 in one university hospital in Finland. Eighty-two practitioners from five wards participated in the project and 10 experienced supervisors implemented their team supervision.

AIM

The aim of this qualitative study is to describe the experiences of five supervisor pairs (n=10) of multiprofessional team supervision.

METHODS

Data were collected by semi-structured interviews from the supervisor pairs. The interviewing style was open and followed that of a guided conversation between supervisors and researcher. Interview data were analysed using thematic content analysis.

FINDINGS

The factors that influenced team supervision were as follows: advanced knowledge of supervision and confidence in supervisors, commitment and motivation, interaction and collaborative relationships and the arrangements of team supervision. The positive effects of team supervision as identified by the supervisors were as follows: influence on interaction and human relationships in the work community, supervisees' strengthened professional identity and the development of multiprofessional practice.

CONCLUSIONS

Several factors can promote or inhibit the achievements of team supervision. Regardless of all the difficulties related to team supervision, its effects on a work community are positive. For the supervisors, team supervision is a demanding and challenging but also a rewarding process.