The establishment and value of peer group clinical supervision: A qualitative study of stakeholders' perspectives

AIMS

Explore perspectives of steering group members and external clinical supervision facilitators of developing and establishing peer group clinical supervision.

BACKGROUND

The climate of healthcare is complex which can lead to staff burnout and challenges to practice. Clinical supervision is suggested as an approach to managing and leadership of such complexities.

DESIGN

Qualitative descriptive.

METHODS

Focus group interviews with 19 members of the peer group clinical supervision steering groups and individual interviews with five external clinical supervision facilitators from the Western region of Ireland were conducted. Data analysis followed Elo and Kyngäs' content analysis method, involving preparation, organising and reporting, to extract meaning and identify patterns from the qualitative data collected.

RESULTS

Developing peer group clinical supervision practice requires, clarity of purpose and function that address the pros and cons of clinical supervision. Organisational leadership is required to support and release staff for peer group clinical supervision and peer group clinical supervisors need to be credible and have a level of expertise in practice. When prepared and supported, the aspects of confidence, leadership, personal development and resilience develop.

CONCLUSION

Peer group clinical supervisors need training and ongoing continual professional development for their role, scope of practice and responsibilities. Sustainability rests on staff awareness and familiarity with the purpose and format of peer group clinical supervision and the regularity of sessions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Peer group clinical supervision is a means of supporting improvement of patient care delivery while in parallel supporting personal and professional development of staff, building resilience in the workplace.

IMPACT

This study explored the implementation of peer group clinical supervision for staff across nursing and midwifery disciplines. It found that implementing peer group clinical supervision had a positive impact on staff well-being and morality and on patient care delivery. These findings influence healthcare service providers in implementing peer group clinical supervision in a sustainable way enabling nurses to continue working in complex healthcare environments delivering safe person-centred care.

REPORTING METHOD

The qualitative reporting guidelines Standards for Reporting Qualitative Research (SRQR) were followed.

PATIENT OR PUBLIC CONTRIBUTION

Patient/public involvement was addressed in this study by staff, managers, planners, directors, leaders and educationalists being involved at all stages of the study (concept, design, analysis and reporting).

The effect of the clinical supervision model on nursing internship students' nursing process-based performance: an experimental study

BACKGROUND

The nursing process is a systematic method for identifying the patient's problems and planning to resolve them. It is also a crucial pillar of high-quality nursing care. Nursing internship students may lack the necessary skills to implement the nursing process due to the increased independence, the absence of constant professorial supervision, and limited experience. The clinical supervision model is a method of clinical education that bridges the gap between theory and practice.

OBJECTIVE

This study was conducted to investigate the impact of the clinical supervision model on the performance of nursing internship students in each of the five stages of the nursing process, as well as overall.

METHOD

This experimental study was conducted in 2022. The 70 eligible internship students were conveniently selected and randomly assigned to either an intervention or a control group. In the present study, the clinical supervision model was implemented for the intervention group, while the control group received routine supervision. This was carried out over six sessions in three months. The data collection was conducted using a researcher-developed checklist of nursing process-based performance in both groups. Moreover, the Manchester questionnaire was used to evaluate the model in the intervention group. The variables considered as confounding factors included age, gender, marital status, number of monthly shifts, and grades of the nursing process credit completed in the third semester. SPSS version 16 software, descriptive statistics (frequency distribution, percentage, mean, and standard deviation), and analytical statistics (independent t-test, chi square, repeated measures Anova and LSD) were used to analyze the data.

RESULTS

Intergroup analysis revealed that there was no significant difference between the scores of nursing process steps and the total score before the intervention in the control and intervention groups, as well as in baseline characteristics (P > 0.05). According to the intragroup analysis, the intervention group showed a significant increase in both the total scores and scores of nursing process steps over time (P < 0.001), whereas the control group exhibited contradictory results (P > 0.05). Finally, the "P-Value Intervention" demonstrated the effectiveness of this training model in improving the performance of the intervention group based on the nursing process compared to the control group. The mean score of the Manchester questionnaire in the intervention group was 136.74, indicating the high impact of implementing the clinical supervision model in the intervention group.

CONCLUSION

The results indicated that the implementation of the clinical supervision model led to improved utilization of the nursing process by nursing internship students at all stages. Therefore, it is recommended that nurse educators utilize the clinical supervision model by providing feedback on errors in action during supervision sessions to enhance the quality of nursing care provided by nursing internship students and improve patient safety in clinical environment.

A mixed-method approach to examining the experiences of allied health clinicians and managers of the performance, appraisal and development framework in a regional health care service

INTRODUCTION

Evaluating employee performance is important for organisational success however, limited research exists across the allied health workforce.

OBJECTIVE

This study investigated allied health clinician and manager experiences and perceptions of the appropriateness of the performance and development (PAD) framework.

DESIGN

A mixed methods design with purposive sampling was conducted in a medium size hospital and health service in regional Queensland to investigate the appropriateness of the PAD framework. A 29 item online survey collected likert scale and open ended responses. Identified respondents also completed a semi-structured interview. Aggregated satisfaction scores identifying PAD alignment, processes, education, resources and perceptions were analysed to identify organisational PAD appropriateness. Themes from interviews provided concurrent experiential data.

FINDINGS

Eighty-five respondents completed the online survey and 20 interviews were conducted. A Chi-Square Goodness of Fit test revealed a significant (p < 0.05) clinician (n = 75) response of moderate dissatisfaction (36%) for the PAD framework, while managers (n = 10) were neither dissatisfied nor satisfied (50%) or moderately satisfied (40%). Clinician aggregated agreement responses were significantly (p < 0.05) higher for PAD alignment (45%), processes (63%), education (49%) and lower for feedback (33%) and resources (28%). Manager aggregated agreement responses were high for PAD alignment (85%), processes (55%), education (57%), feedback (65%) and perceptions (50%). Interviews (n = 20) revealed three themes: uncertainty around PAD framework; expectations for experienced leadership and importance of discipline specific knowledge.

DISCUSSION

This study draws on both clinician and manager input to assess the overall PAD framework with responses favouring clinician dissatisfaction to the current process.

CONCLUSION

The PAD framework is valuable for staff development when there is positive rapport and discipline alignment between both clinician and manager. Successful staff appraisals require efficient and appropriate documentation that promotes individual development, clinical performance and organisational priorities.

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.

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.

Effectiveness of allied health clinical supervision following the implementation of an organisational framework

Background

Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians’ perceptions of the implementation of an organisational clinical supervision framework.

Methods

A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA.

Results

There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation’s clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision.

Conclusions

Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.

Improvement in the Short-Term Effectiveness of the Clinical Supervision of Physiotherapists Who Have Taken Part in a Clinical Supervision Training Programme

Purpose: The purpose of this study was to evaluate change in the effectiveness of clinical supervision of physiotherapists who took part in a clinical supervision training programme. Method: Our pre-post study design used both quantitative and qualitative methods. The programme consisted of three interactive sessions held with physiotherapists from a metropolitan public health network in Melbourne, Victoria, Australia. The effectiveness of clinical supervision of supervisees was measured using the Manchester Clinical Supervision Scale (MCSS-26). The effectiveness of clinical supervision from the supervisors' perspective was measured using a clinical supervisor questionnaire. The physiotherapists' experience of participating in the training programme was then explored in focus groups. Results: A total of 36 physiotherapists participated in the training programme. Twelve weeks later, the physiotherapists (35) reported a moderate improvement in the effectiveness of clinical supervision, with a mean improvement of 5.4 units (95% CI: 2.0, 8.9; p = 0.003) on the MCSS-26 (score range 0-104). After training, a higher proportion of physiotherapists reported receiving effective clinical supervision (97% after vs. 53% before; p = 0.001). In the focus groups, the physiotherapists reported greater flexibility in their approach to clinical supervision and a more effective supervisory relationship. However, difficulty finding time for supervision remained a barrier. Conclusions: Physiotherapists reported an improvement in the effectiveness of clinical supervision after a clinical supervision training programme.

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.

Group clinical supervision for allied health professionals

OBJECTIVE

To evaluate a group clinical supervision program for allied health professionals in a regional health service.

DESIGN

This study used a mixed-methods design including a cross-sectional, quantitative survey of group clinical supervision participants and a focus group of facilitators.

SETTING

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

PARTICIPANTS

Allied health professionals and managers employed at the health service.

INTERVENTIONS

Group clinical supervision, based on a critical reflection model, was implemented in 3 settings.

MAIN OUTCOME MEASURE

The Clinical Supervision Evaluation Questionnaire was administered to group clinical supervision participants, with additional open-ended questions included. The Clinical Supervision Evaluation Questionnaire tool consists of 3 subscales relating to the purpose, process and impact of group clinical supervision. A focus group was used to capture the perspectives of group clinical supervision facilitators.

RESULTS

Fifteen survey responses were received. The overall Clinical Supervision Evaluation Questionnaire score was 56.53 (standard deviation 7.66). Scores for the Process Subscale were higher than the Purpose and Impact subscales. Themes from the open-ended survey questions included the following: value of multiple perspectives, opportunities for reflection, peer support and group process and structure. Themes from group facilitators' focus group included the following: need for group clinical supervision, value of facilitator training and support, and sustainability.

CONCLUSION

Group clinical supervision was perceived to be effective, enhancing reflection, learning and peer support. Organisational support, facilitator training, group structure and planning for sustainability were identified as critical factors for success. Interprofessional and cross-organisational models of group clinical supervision are strategies that could help address issues relating to access to quality clinical supervision for rural allied health professionals.

Nurses and midwives' experiences with peer-group clinical supervision intervention: A pilot study

AIM

This study aimed to evaluate differences in supervisees' understanding of clinical supervision and their perceptions of organisational functioning before and after engaging in peer-group clinical supervision.

BACKGROUND

Protected reflective time allows discussion of complex issues affecting health care. Peer-group clinical supervision is one model of clinical supervision that could facilitate this, but it is poorly understood.

METHODS

A pre-post intervention pilot study was performed. The intervention was delivered over a 12-month period. Data were collected using surveys on demographic and work-related factors and experience of clinical supervision pre- and post intervention.

RESULTS

Adaptability increased significantly between the pre- and post surveys. The post survey data showed finding time for clinical supervision scoring lowest with open-ended comments reinforcing this. The supervisees found the sessions to offer a safe place despite initial concerns.

CONCLUSION

The peer-group model of clinical supervision allowed supervisees to build a rapport and trust with their colleagues and share experiences.

IMPLICATIONS FOR NURSING MANAGEMENT

The benefits to participating in peer-group clinical supervision traversed the individual and organisation. These data support the implementation of such sessions while addressing workload and time pressures to aid participation.

Factors influencing adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development: An integrative review

WHAT IS KNOWN ON THE SUBJECT

CS was developed to give healthcare professionals a space to reflect, problem solve and recognise their own practice. It is different from managerial supervision as it is for the benefit of the individual staff member's personal and professional development firstly, but can potentially benefit the quality of care delivered by the organisation. There have been a range of problems associated with inpatient mental health nurses' engagement in CS and in experiencing the benefits of CS. This is concerning for the delivery of high quality care and the recruitment and retention of inpatient mental health nurses.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

This paper explores and identifies factors influencing adequate and effective CS for inpatient mental health nurses' personal and professional development. It identifies 6 themes incorporating enablers and barriers for inpatient mental health nurses' CS which lead to practice recommendations for improvement.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

This paper advocates a needs analysis to improve access to CS for inpatient mental health nurses. This review specifically adds further knowledge relating to inpatient mental health nurses' engagement with CS which the application of the needs analysis could influence.

ABSTRACT

Introduction Clinical supervision (CS) has been recognized as a reflective mechanism in inpatient mental health nursing practice; however, it remains unclear what adequate and effective supervision entails for inpatient mental health nurses. Aim To explore factors which influence adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development. Method Whittemore and Knafl's model for ensuring rigour was utilized. This included stages to address problem identification, literature searching, data evaluation, data analysis and presentation. Seven electronic databases were searched with hand searching/Internet searching. Fourteen retrieved articles were selected and appraised using the Mixed Method Appraisal Tool (MMAT). The data extracted from the papers were analysed thematically. Results The review synthesis resulted in identifying six themes: (a) what makes CS effective; (b) reflection; (c) the facilitation of professional identity and knowledge through CS; (d) participation; (e) knowledge and understanding of CS; and (f) the facilitation of personal awareness and coping. Discussion This review adds further knowledge on the identification of effective CS for inpatient mental health nurses as a defined occupational healthcare group. Implications for practice A suggested needs analysis is presented to improve access to CS options with the aim of promoting effective CS and increased engagement.

Physiotherapists Prefer Clinical Supervision to Focus on Professional Skill Development: A Qualitative Study

Purpose: We explored physiotherapists' perceptions of clinical supervision. Method: Individual semi-structured interviews were conducted with a purposive sample of 21 physiotherapists from a public hospital. Qualitative analysis was undertaken using an interpretive description approach. The Manchester Clinical Supervision Scale (MCSS-26) was administered to evaluate the participants' perceptions of the effectiveness of the clinical supervision they had received and to establish trustworthiness in the qualitative data by means of triangulation. Results: The major theme was that the content of clinical supervision should focus on professional skill development, both clinical and non-clinical. Four subthemes emerged as having an influence on the effectiveness of supervision: the model of clinical supervision, clinical supervision processes, supervisor factors, and supervisee factors. All sub-themes had the potential to act as either a barrier to or a facilitator of the perception that clinical supervision was effective. Conclusions: Physiotherapists reported that clinical supervision was most effective when it focused on their professional skill development. They preferred a direct model of supervision, whereby their supervisor directly observed and guided their professional skill development. They also described the importance of informal supervision in which guidance is provided as issues arise by supervisors who value the process of supervision. Physiotherapists emphasized that supervision should be driven by their learning needs rather than health organization processes.

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

BACKGROUND

Clinical supervision is recommended for allied health professionals for the purpose of supporting them in their professional role, continued professional development and ensuring patient safety and high quality care. The aim of this mixed methods study was to explore allied health professionals' perceptions about the aspects of clinical supervision that can facilitate effective clinical supervision.

METHODS

Individual semi-structured interviews were conducted on a purposive sample of 38 allied health professionals working in a metropolitan public hospital. Qualitative analysis was completed using an interpretive description approach. To enable triangulation of qualitative data, a quantitative descriptive survey of clinical supervision effectiveness was also conducted using the Manchester Clinical Supervision Scale (MCSS-26).

RESULTS

Three main themes emerged from qualitative analysis: Allied health professionals reported that clinical supervision was most effective when their professional development was the focus of clinical supervision; the supervisor possessed the skills and attributes required to facilitate a constructive supervisory relationship; and the organisation provided an environment that facilitated this relationship together with their own professional development. Three subthemes also emerged within each of the main themes: the importance of the supervisory relationship; prioritisation of clinical supervision relative to other professional duties; and flexibility of supervision models, processes and approaches to clinical supervision. The mean MCSS-26 score was 79.2 (95%CI 73.7 to 84.3) with scores ranging from 44 to 100. MCSS-26 results converged with the qualitative findings with participants reporting an overall positive experience with clinical supervision.

CONCLUSIONS

The factors identified by allied health professionals that influenced the effectiveness of their clinical supervision were mostly consistent among the professions. However, allied health professionals reported using models of clinical supervision that best suited their profession's role and learning style. This highlighted the need for flexible approaches to allied health clinical supervision that should be reflected in clinical supervision policies and guidelines. Many of the identified factors that influence the effectiveness of clinical supervision of allied health professionals can be influenced by health organisations.

Debriefing about the challenges of working in a remote area: A qualitative study of Australian allied health professionals' perspectives on clinical supervision

Background

The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants’ lived experiences with clinical supervision at the frontline.

Methods

Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews.

Results

Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision.

Conclusions

This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention.

The association between effectiveness of clinical supervision of allied health professionals and improvement in patient function in an inpatient rehabilitation setting

Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective clinical supervision of allied health professionals improves patients' outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence. Methods: A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure.Results: Physiotherapists (n = 27) and occupational therapists (n = 26) in inpatient rehabilitation were recruited and the medical records of their patients (n = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence.Conclusions: Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients' mobility or personal care, respectively.Implications for rehabilitationEffective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients.Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision.Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice.Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.

Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface

Objective The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results Supervisee’s work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic? There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add? This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners? Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice.

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.

Clinical supervision for allied health staff: necessary but not sufficient

Objectives The aim of the present study was to explore the perspectives of allied health professionals on appropriate content for effective clinical supervision of staff. Methods A set of statements regarding clinical supervision was identified from the literature and confirmed through a Q-sort process. The final set was administered as an online survey to 437 allied health professionals working in two Australian health services. Results Of the 120 respondents, 82 had experienced six or more clinical supervision sessions and were included in the analysis. Respondents suggested that clinical supervision was beneficial to both staff and patients, and was distinct from line management performance monitoring and development. Curiously, some of the respondents did not agree that observation of the supervisee's clinical practice was an aspect of clinical supervision. Conclusions Although clinical supervision is included as a pillar of clinical governance, current practice may not be effective in addressing clinical risk. Australian health services need clear organisational policies that outline the relationship between supervisor and supervisee, the role and responsibilities of managers, the involvement of patients and the types of situations to be communicated to the line managers. What is known about the topic? Clinical supervision for allied health professionals is an essential component of clinical governance and is aimed at ensuring safe and high-quality care. However, there is varied understanding of the relationship between clinical supervision and performance management. What does this paper add? This paper provides the perspectives of allied health professionals who are experienced as supervisors or who have experienced supervision. The findings suggest a clear role for clinical supervision that needs to be better recognised within organisational policy and procedure. What are the implications for practitioners? Supervisors and supervisees must remember their duty of care and ensure compliance with organisational policies in their clinical supervisory practices.

Effective use of technology in clinical supervision

Clinical supervision is integral to continuing professional development of health professionals. With advances in technology, clinical supervision too can be undertaken using mediums such as videoconference, email and teleconference. This mode of clinical supervision is termed as telesupervision. While telesupervision could be useful in any context, its value is amplified for health professionals working in rural and remote areas where access to supervisors within the local work environment is often diminished. While telesupervision offers innovative means to undertake clinical supervision, there remain gaps in the literature in terms of its parameters of use in clinical practice. This article outlines ten evidence-informed, practical tips stemming from a review of the literature that will enable health care stakeholders to use technology effectively and efficiently while undertaking clinical supervision. By highlighting the "how to" aspect, telesupervision can be delivered in the right way, to the right health professional, at the right time.

Can clinical supervision sustain our workforce in the current healthcare landscape? Findings from a Queensland study of allied health professionals

OBJECTIVE

Clinical supervision is widely recognised as a mechanism for providing professional support, professional development and clinical governance for healthcare workers. There have been limited studies about the effectiveness of clinical supervision for allied health and minimal studies conducted within the Australian health context. The aim of the present study was to identify whether clinical supervision was perceived to be effective by allied health professionals and to identify components that contributed to effectiveness. Participants completed an anonymous online questionnaire, administered through the health service's intranet.

METHODS

A cross-sectional study was conducted with community allied health workers (n = 82) 8 months after implementation of structured clinical supervision. Demographic data (age, gender), work-related history (profession employment level, years of experience), and supervision practice (number and length of supervision sessions) were collected through an online survey. The outcome measure, clinical supervision effectiveness, was operationalised using the Manchester Clinical Supervision Scale-26 (MCSS-26). Data were analysed with Pearson correlation (r) and independent sample t-tests (t) with significance set at 0.05 (ie the probability of significant difference set at P < 0.05).

RESULTS

The length of the supervision sessions (r(s) ≥ 0.44), the number of sessions (r(s) ≥ 0.35) and the total period supervision had been received (r(s) ≥ 0.42) were all significantly positively correlated with the MCSS-26 domains of clinical supervision effectiveness. Three individual variables, namely 'receiving clinical supervision', 'having some choice in the allocation of clinical supervisor' and 'having a completed clinical supervision agreement', were also significantly associated with higher total MCSS-26 scores (P(s) < 0.014).

CONCLUSION

The results of the study demonstrate that when clinical supervision uses best practice principles, it can provide professional support for allied health workers, even during times of rapid organisational change.

Public sector physiotherapists believe that staff supervision should be broad ranging, individualised, structured, and based on needs and goals: a qualitative study

QUESTION

What do physiotherapists consider to be the structure and content of an effective clinical supervision program for public sector staff?

DESIGN

Qualitative study using emergent-systematic focus group design.

PARTICIPANTS

46 physiotherapists and six physiotherapy assistants from a large, regional, Australian health service participated in one of seven focus groups.

RESULTS

Data were represented by three major categories: the content of supervision; the structure of supervision; and participants' roles and attributes. The content of supervision should encompass all issues affecting workplace experience and performance; supervision should be individualised and needs based. For the structure of supervision, a variety of methods and formats should be available, including: scheduled and unscheduled supervision (unscheduled supervision addresses needs as they arise but its usefulness can be restricted by supervisor availability); the environment should be organised to facilitate supervision; supervision should be integrated into existing practices; and supervision should be adequately prioritised and resourced to enable sustainability. In relation to participants' roles and attributes, respondents recommended: clearly defined supervisor and supervisee roles, responsibilities, skills and attributes are required to facilitate a constructive relationship on which successful supervision depends; the supervisee should take primary responsibility for leading and organising their supervision; the supervisor provides support and accountability and assists with goal setting and attainment; and successful supervision requires considerable knowledge and skills from the supervisee and supervisor (supervision education and training might be necessary).

CONCLUSION

The physiotherapists' perspectives that were identified in this study are important to consider when assessing current clinical supervision models, as well as when designing and implementing effective physiotherapy supervision programs.

Enablers of and barriers to high quality clinical supervision among occupational therapists across Queensland in Australia: findings from a qualitative study

BACKGROUND

Health professionals practising in countries with dispersed populations such as Australia rely on clinical supervision for professional support. While there are directives and guidelines in place to govern clinical supervision, little is known about how it is actually conducted and what makes it effective. The purpose of this study was to explore the enablers of and barriers to high quality clinical supervision among occupational therapists across Queensland in Australia.

METHODS

This qualitative study took place as part of a broader project. Individual, in-depth, semi-structured interviews were conducted with occupational therapy supervisees in Queensland. The interviews explored the enablers of and barriers to high quality clinical supervision in this group. They further explored some findings from the initial quantitative study.

RESULTS

Content analysis of the interview data resulted in eight themes. These themes were broadly around the importance of the supervisory relationship, the impact of clinical supervision and the enablers of and barriers to high quality clinical supervision.

DISCUSSION

This study identified a number of factors that were perceived to be associated with high quality clinical supervision. Supervisor-supervisee matching and fit, supervisory relationship and availability of supervisor for support in between clinical supervision sessions appeared to be associated with perceptions of higher quality of clinical supervision received. Some face-to-face contact augmented with telesupervision was found to improve perceptions of the quality of clinical supervision received via telephone. Lastly, dual roles where clinical supervision and line management were provided by the same person were not considered desirable by supervisees. A number of enablers of and barriers to high quality clinical supervision were also identified.

CONCLUSION

With clinical supervision gaining increasing prominence as part of organisational and professional governance, this study provides important lessons for successful and sustainable clinical supervision in practice contexts.

A systematic review of professional supervision experiences and effects for allied health practitioners working in non-metropolitan health care settings

Introduction

In regional, rural, and remote settings, allied health professional supervision is one organizational mechanism designed to support and retain the workforce, provide clinical governance, and enhance service delivery. A systematic approach to evaluating the evidence of the experience and effects of professional supervision for non-metropolitan allied health practitioners and their service delivery is needed.

Methods

Studies investigating the experience and effects of professional supervision across 17 allied health disciplines in non-metropolitan health services were systematically searched for using standardized keywords across seven databases. The initial search identified 1,574 references. Of these studies, five met inclusion criteria and were subject to full methodological appraisal by both reviewers. Two studies were primarily qualitative with three studies primarily quantitative in their approach. Studies were appraised using McMaster critical appraisal tools and data were extracted and synthesized.

Results

Studies reported the context specific benefits and challenges of supervision in non-metropolitan areas and the importance of supervision in enhancing satisfaction and support in these areas. Comparison of findings between metropolitan and non-metropolitan settings within one study suggested that allied health in non-metropolitan settings were more satisfied with supervision though less likely to access it and preferred supervision with other non-metropolitan practitioners over access to more experienced supervisors. One study in a regional health service identified the lack of an agreed upon definition and functions of supervision when supervisors from diverse allied health disciplines were surveyed. While methodologically weak, all studies reported positive perceptions of supervision across professionals, supervisors, and managers. This is in accordance with previous research in the wider supervision literature.

Discussion

Considering the large pool of studies retrieved for further investigation, few of these met inclusion criteria demonstrating the paucity of primary research in this area. Increased training, policies, and implementation frameworks to ensure the definition and functions of supervision are agreed upon across the allied health disciplines in non-metropolitan areas is needed. Furthermore, systematic evaluation of supervision implementation in non-metropolitan settings, investigation of the experience and effects of distance based supervision (versus face-to-face), and increased rigor in research studies investigating non-metropolitan allied health profession supervision is needed.

Effectiveness of clinical supervision of physiotherapists: a survey

OBJECTIVES

Limited literature exists on the practice of clinical supervision (CS) of professional physiotherapists despite current Australian safety and quality health standards stating that CS is to be provided to all physiotherapists. The aim of the present study was to evaluate the effectiveness of CS of physiotherapists working in an Australian public health service.

METHODS

CS was measured using the allied health-specific 26-item modified Manchester Clinical Supervision Scale (MCSS-26). Subscales of the MCSS-26 were summed for three domain scores (normative, restorative and formative) and a total score was calculated, which was compared with the reported threshold score of 73 for effective supervision. Sixty registered physiotherapists (response rate 92%), working for a large metropolitan public health service, with six different site locations, completed the survey.

RESULTS

The mean (± s.d.) total MCSS-26 score was 71.0 ± 14.3 (95% confidence interval (CI) 67.4-74.6). Hospital site was the only variable that had a significant effect on total MCSS-26 score (P=0.005); there was no effect for supervisor or supervisee experience, or hospital setting (acute vs subacute). Physiotherapists scored a significantly lower mean percentage MCSS-26 score on the normative domain compared with the restorative domain (mean difference 7.8%; 95% CI 2.9-12.7; P=0.002) and the formative domain (mean difference 9.6%; 95% CI 6.3-13.0; P<0.001). Of the two subscales that form the normative domain, 'finding time' had a significantly lower mean percentage MCSS-26 score than 'importance/value of CS' (mean difference 35.4%; 95% CI 31.3-39.4; P<0.001).

CONCLUSIONS

Within this publicly funded physiotherapy department there was uncertainty about the effectiveness of CS, with more than half the physiotherapists rating their supervision as less than effective, suggesting there is opportunity for improvement in the practice of physiotherapy CS. Physiotherapists scored lowest in the normative domain, indicating that they found it difficult to find time for CS.

Oceans apart, yet connected: Findings from a qualitative study on professional supervision in rural and remote allied health services

OBJECTIVE

Improving the quality and safety of health care in Australia is imperative to ensure the right treatment is delivered to the right person at the right time. Achieving this requires appropriate clinical governance and support for health professionals, including professional supervision. This study investigates the usefulness and effectiveness of and barriers to supervision in rural and remote Queensland.

DESIGN

As part of the evaluation of the Allied Health Rural and Remote Training and Support program, a qualitative descriptive study was conducted involving semi-structured interviews with 42 rural or remote allied health professionals, nine operational managers and four supervisors. The interviews explored perspectives on their supervision arrangements, including the perceived usefulness, effect on practice and barriers.

RESULTS

Themes of reduced isolation; enhanced professional enthusiasm, growth and commitment to the organisation; enhanced clinical skills, knowledge and confidence; and enhanced patient safety were identified as perceived outcomes of professional supervision. Time, technology and organisational factors were identified as potential facilitators as well as potential barriers to effective supervision.

CONCLUSIONS

This research provides current evidence on the impact of professional supervision in rural and remote Queensland. A multidimensional model of organisational factors associated with effective supervision in rural and remote settings is proposed identifying positive supervision culture and a good supervisor-supervisee fit as key factors associated with effective arrangements.

Evaluation of an inter-professional training program for student clinical supervision in Australia

BACKGROUND

As a response to an Australian shortage of clinical health, nursing, and medical placements, Commonwealth Government funding has been directed to expand student training opportunities and increase the competence and number of available clinical supervisors. This paper evaluates the application of a particular supervision training model for this purpose. It considers the model's suitability and relevance across professions and its impact on supervisory knowledge, skills, and values as well as the intention to supervise students.

METHODS

The design, delivery, and evaluation of a series of one-day introductory student clinical supervision training workshops for allied health disciplines, nursing, and medicine are considered. Participants evaluated Proctor's model of clinical supervision, which was expanded by the trainers to incorporate diversity and power relations in student supervision.

RESULTS

Evaluation results suggest that adapting Proctor's model for student clinical supervision is relevant across a broad range of health disciplines and clinical areas. Participants from 11 health professions reported that the training improved their knowledge, skills, and values and expanded their willingness to accept student clinical placements. The outcomes are suggestive of enhanced clinical supervision intent, capacity, and capability.

CONCLUSIONS

The student supervision training improved participants' confidence in their clinical supervision skills. The findings suggest that the training has the potential to extend capacity and capability for student supervision across health professions and in Health Workforce Australia's identified priority areas of mental health, community health, rehabilitation, private practice, and non-government organisations. Findings also indicate that these gains are reliant on health organizations developing and sustaining cultures of learning.

Barriers to, and enablers of, participation in the Allied Health Rural and Remote Training and Support (AHRRTS) program for rural and remote allied health workers: a qualitative descriptive study

BACKGROUND

Allied health professionals play a critical role in enhancing health outcomes in primary and tertiary settings. Issues affecting the recruitment and retention of allied health workers in rural and remote areas are multifactorial. Access to relevant and effective continuing professional development is argued to be a recruitment and retention strategy for health professionals in non-metropolitan areas, however trial of the effectiveness of professional development programs and identification of enablers and barriers to participation is needed. The Allied Health Rural and Remote Training and Support (AHRRTS) program aimed to provide an integrated program of education and professional support activities for allied health professionals working within Queensland Health in rural and remote locations. The aim of this study was to explore enablers and barriers to access to, and effective participation in, the AHRRTS program from various allied heath stakeholders' perspectives.

METHODS

A qualitative descriptive study utilising semi-structured interviews with various allied heath stakeholders was undertaken. The interview questions focussed on a number of issues pertinent to AHRRTS program, with specific probing questions regarding barriers and enablers to participation in the AHRRTS program. The interviews were then transcribed verbatim and analysed using thematic analysis.

RESULTS

Using purposive sampling, a total of 55 stakeholders were interviewed for this study. Time, organisational factors and travel were identified as common barriers and organisational factors, travel and presentation modes were identified as common enablers. Interestingly, some of these factors act as barriers and/or enablers highlighting that these are essentially two sides of the same coin. The findings suggest that while it is important to have policies and procedures for ongoing support of allied health professionals, it should be complemented by enabling strategies to address persistent barriers.

CONCLUSION

The study suggests that while a program such as AHRRTS is accessible and facilitates participation in a number of ways, significant barriers to participation continue to persist at the coal face. Addressing these barriers will require a targeted, multifaceted approach. Lessons from this study provide unique insights into factors which influence the successful implementation and sustainability of recruitment and retention initiatives for rural and remote allied health workers.

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.