Clinical Supervision in Promoting a Balanced Delivery of Palliative Nursing Care

Nursing clinical supervision project in a Neonatal Intensive Care and a Special Care Baby Unit: a best practice implementation project

BACKGROUND

Clinical supervision is a process of guided reflective practice and is used in the areas of mental health and palliative care. However, within the Neonatal Intensive Care Unit setting, stressful situations may also arise, with no policies for nurses in regards to participation in clinical supervision. With critical incidents, complex family issues and loss of nursing expertise, clinical supervision could be a potential solution to this dilemma.

AIMS AND OBJECTIVES

The aims of the project were to investigate if any hospital policies supported clinical supervision. Specifically, the aims were: (i) to conduct an audit of nurses' knowledge on the topic of clinical supervision, (ii) to investigate if nurses were aware of, or had been involved in, any clinical supervision activities conducted in a Neonatal Intensive Care Unit or a Special Care Baby Unit, and (iii) to investigate if records are maintained of any clinical supervision activities held.

METHODS

A three-phase approach was initiated for this project: a baseline audit, implementation of education sessions, and a follow-up audit using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The Neonatal Intensive Care Unit and Special Care Baby Unit have approximately 180 registered nurses working in the units where the project was conducted. The baseline audit included 37 nurses by convenience sampling and the follow-up audit included nine of these nurses.

RESULTS

No policy on clinical supervision has been developed to support nurses in the Neonatal Intensive Care Unit and Special Care Baby Unit. The baseline audit found that nurses described clinical supervision as educational and task orientated, and did not equate clinical supervision with a process that could be also described as "guided reflective practice". Following the education sessions, there was a better understanding of what clinical supervision entailed and the benefits that could lead to improved professional practice, but there were no activities in which nurses could engage in this process.

CONCLUSIONS

Implementation of a pilot project to test the evidence of clinical supervision in the Neonatal Intensive Care and Special Care Baby speciality units should be undertaken with strategies to assess the effectiveness of clinical supervision and the positive aspects that have been reported in the literature.

The need for palliative care education, support, and reflection among rural nurses and other staff: A quantitative study

Objective:

Many people now die in community care, and, considering the aging population, all healthcare staff members must be prepared to provide palliative care. Our objectives were to describe the total staff working in different care organizations in a rural community in Sweden and to explore palliative care competence, to describe educational gaps and the need for support and reflection, and to determine whether there are differences in care organizations, professions, age, and gender.

Method:

A 4-section 20-item questionnaire was distributed to 1686 staff (65% response rate): in nursing homes (n = 395), home care (n = 240), and group residential settings (n = 365). Registered nurses (n = 70), assistant nurses (n = 916), managers (n = 43), and paramedics (n = 33) participated. Descriptive and correlational statistics were employed.

Results:

Significant differences were found, and 40% (53% among men) lacked palliative care education, Fewer than 50% lacked education in the spiritual/existential areas, and 75% of those aged 20–66 (75% women, 55% men) needed further education. More women than men and staff aged 50–59 had an increased need to reflect.

Significance of Results:

Our study may provide guidance for managers in rural communities when planning educational interventions in palliative care for healthcare staff and may support direct education with content for specific professions.

Changes in emotion work at interdisciplinary conferences following clinical supervision in a palliative outpatient ward

In this article, I describe changes in emotion work at weekly interdisciplinary conferences in a palliative( 1) outpatient ward following clinical supervision (CS). I conceive emotions as constantly negotiated in interaction, and I researched the similarity between how this is done during CS and at interdisciplinary conferences following CS. In this respect, CS is seen as a particular discursive practice for emotion work. The findings show how conferences following supervision become inspired by the "language game" in CS, initiating metaperspectives on the care and treatment of patients. These metaperspectives illuminate a dual aspect of care in the sense that it serves the needs not only of patients but also team members. I argue that this recognition captures one of the great challenges in palliative care, namely, to separate the carer's own needs and emotions from those of patients. I therefore conclude that CS enhances professional development and may prevent burnout in palliative care.

Caring for dying patients outside special palliative care settings: experiences from a nursing perspective

The aim of the study was to describe nurses' experiences in caring for gravely ill and dying patients outside special palliative care settings. Tape-recorded qualitative interviews were conducted with a total of nine nurses in primary home care, community care and hospitals. The interviews were analysed according to phenomenological methodology, which resulted in the three common structures: ambition and dedication, everyday encounters, and satisfaction/dissatisfaction. In the 'everyday encounters' structure, the following key constituents emerged: responsibility, cooperation, experience and knowledge, feelings, and time and resources. The results describe the nurses' high ambitions to give dying patients and their relatives high-quality care. Despite this, they experienced greater or lesser degrees of dissatisfaction because of insufficient cooperation, support, time and resources. They experienced satisfaction through contact with patients and relatives, functioning collegial cooperation, and the knowledge, experience and personal growth the care had given them. The results indicate that nurses need the resources such as time, improved methods of communication and cooperation as well as more support in order to give quality palliative care and achieve satisfaction with the outcome. The need for discussion about the conditions for giving palliative care outside the hospices and other special palliative care settings is also elucidated.