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

A metasynthesis of nurses and midwives' experiences of clinical supervision

PROBLEM

Given the current rate of burnout and attrition among nurses and midwives globally, there is a need to understand the effectiveness of supportive strategies to help retain this workforce.

BACKGROUND

Clinical supervision can help to ensure that nurses and midwives are supported and have the capacity to cope with their job demands. Yet there are no metasyntheses that provide a collective understanding of their experiences with clinical supervision.

AIM

To synthesise the experiences of nurses and midwives who have accessed clinical supervision.

METHODS

A metasynthesis was conducted by systematically searching academic databases for relevant publications; assessing their quality using an established checklist; extracting and analysing qualitative content; and synthesising key findings about the experiences of nurses and midwives regarding clinical supervision.

FINDINGS

Themes and subthemes were identified from 12 papers, including: optimal logistics; support; safety and confidentiality; improving practice through reflection; and trust in the group.

DISCUSSION

For clinicians to feel comfortable discussing their practice and workplace with the facilitator and colleagues, nurses and midwives needed to feel safe during clinical supervision and trust the process and their peers. Despite common difficulties of finding time for the sessions, clinical supervision can enhance collaboration and communication in the workplace.

CONCLUSION

Clinical supervision that adheres to group rules can provide professional support within a safe, confidential space. Having trust in peers and facilitators at the sessions can help staff develop confidence, provide personal development and professional sustenance.

Job Satisfaction and Burnout Levels of the Human Resources of a Public Oncology Hospital During the COVID-19 Pandemic

To investigate job satisfaction and burnout levels among the personnel of a public oncology hospital amid the COVID-19 pandemic, a cross-sectional survey was designed. The study was carried out from December 2021 to January 2022 through the application of an anonymous, structured, self-completed, closed-ended questionnaire, consisting of the Job Satisfaction Survey (JSS) and the Copenhagen Burnout Inventory (CBI) in a convenience sample comprised by 117 employees of "Agioi Anargyroi" General Oncology Hospital (response rate: 98%). It was observed that while overall job satisfaction was reduced, several of its determining dimensions like supervision, relationship with co-workers, or work nature were increased. Also, an average overall burnout of 49% was observed across all participants, with women, nurses, and those with a lower educational level experiencing it more intensely. The COVID-19 pandemic outbreak affected negatively healthcare professionals who experienced significant personal and occupational burnout, consequently reducing their job satisfaction.

The Impact of COVID-19 on Burnout, Psychological Well-being, and Work Satisfaction in Psychiatry Trainees in Ireland

OBJECTIVE

Prior to the pandemic, trainee doctors were at higher risk of psychological ill health. There is limited evidence measuring the impact of COVID-19 on psychiatry trainees. This study evaluates levels of burnout, work satisfaction, and psychological well-being in psychiatry junior doctors in Ireland and identifies potential contributing factors.

METHODS

The authors carried out a cross-sectional online survey measuring demographic and work-related variables. Questions including exposure to COVID-19 and stress-related factors were included. We evaluated burnout, work satisfaction, and psychological well-being using the Abbreviated-Maslach Burnout Inventory, Basic Needs Satisfaction at Work Scale, and WHO-5 Well-being Index.

RESULTS

One hundred and five doctors responded (21%). The biggest stressor reported was reduced face-to-face contact with family and friends (73%). Forty one percent reported weekly supervision changes. Sixty five percent met the criteria for burnout, compared with 36.2% in 2018. Significant factors associated with burnout included staff shortages, longer hours, and less experience. Changes in supervision and working in non-European Working Time Directive compliant rotas were associated with lower scores across all subdomains of the BNSW Scale. The WHO-5 Well-being Index identified 48% scored low in personal well-being, indicating these trainees met the threshold for depression. Changes in regular supervision (p=0.010) were a significant predictor of low personal well-being.

CONCLUSIONS

High prevalence of burnout and low levels of well-being in this vulnerable cohort, particularly those who are inexperienced, have changes in supervision, and working longer hours is concerning. This study highlights the importance of regular supervision and support for this group.

Scoping review with textual narrative synthesis of the literature reporting stress and burn-out in specialist nurses: making the case for inflammatory bowel disease nurse specialists

Objective

Inflammatory bowel disease clinical nurse specialists (IBD-CNSs) face increasing pressures due to rising clinical and patient demands, advanced complexity of work role, and minimal specialist management training and support. Stress and burn-out could undermine the stability of this workforce, disrupting clinical provision. We reviewed the literature on stress and burn-out to demonstrate the lack of evidence pertinent to IBD-CNSs and make the case for further research.

Design

Following Levac et al’s scoping review framework, relevant databases were searched for publications reporting work-related stress and burn-out among specialist nurses. Following screening and consensus on selection of the final articles for review, all authors contributed to data charting. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension guided reporting of the review.

Results

Of 194 retrieved articles, eight were eligible for review. None focused on IBD-CNSs, were qualitative, or UK-based. Three core themes were identified: Rates of Burn-out, Mitigating and Alleviating Factors, and Preventing and Resolving Burn-out. Risk of burn-out is greatest in novice and mid-career CNSs. Age and duration in role appear protective. Personal achievement is also protective and can mitigate earlier episodes of burn-out; opportunities for career progression are limited. Promoting personal well-being is beneficial. Senior managers have poor understanding of the role and provide inadequate support. Commitment to patients remains high.

Conclusion

Burn-out arises in CNSs across clinical specialisms in the international literature and has a significant negative effect on the workforce. Further research is needed to address the dearth of evidence on burn-out in IBD-CNSs in the UK.

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.

Determinants of safety climate at primary care level in Ghana, Malawi and Uganda: a cross-sectional study across 138 selected primary healthcare facilities

BACKGROUND

Safety climate is an essential component of achieving Universal Health Coverage, with several organisational, unit or team-level, and individual health worker factors identified as influencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda.

METHODS

A cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisational-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country.

RESULTS

Our model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.34, p < 0.001), and district managerial support (β = 0.29, p < 0.001). In Ghana, safety climate was positively associated with job satisfaction (β = 0.30, p < 0.05), teamwork (β = 0.46, p < 0.001), and supportive supervision (β = 0.21, p < 0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.43, p < 0.001), and perceived district managerial support (β = 0.35, p < 0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (β = 0.39, p = 0.005) and supportive supervision (β = 0.27, p = 0.023) significantly and positively associated with safety climate.

DISCUSSION/CONCLUSIONS

Our findings highlight the importance of unit-level factors-and in specific, teamwork and supportive supervision-as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed.

Burnout, Work Satisfaction, and Well-being Among Non-consultant Psychiatrists in Ireland

OBJECTIVE

The aim of this study was to explore the areas of psychological well-being, satisfaction at work, and burnout among non-consultant psychiatrists in Ireland, and to assess for potential contributory factors.

METHODS

The College of Psychiatrists of Ireland distributed the survey online to 100 non-consultant psychiatry doctors working in Ireland. The survey contained questions relating to demographic and work-related variables, the Abbreviated-Maslach Burnout Inventory (a-MBI), Basic Needs Satisfaction at Work (BNSW) scale, and WHO-5 Well-being Index. Descriptive statistics were used by the authors to summarize the data and univariate associations were explored between baseline data and subscales.

RESULTS

Sixty-nine percent of our sample completed the survey. Thirty-six percent of the sample met the criteria for burnout, with lack of supervision the only variable significantly associated with this. Lack of regular supervision was associated with lower scores across all work satisfaction domains of the BNSW scale. The WHO-5 Well-being Index identified that 30% of respondents scored low in personal well-being, indicating that this proportion screened positive for depression, based on international diagnostic criteria. Lack of regular supervision was found to be significantly associated with low psychological well-being.

CONCLUSION

This study indicates that lack of supervision is significantly associated with burnout, lower satisfaction at work, and poorer psychological well-being. Close evaluation of these areas is important to identify vulnerable individuals and areas of training which can be improved upon, which may lead to relevant measures being implemented for the benefit of psychiatrists, patients, and the wider society.

Lived experiences and caring needs in young adults diagnosed with cancer

AIMS AND OBJECTIVES

To explore the lived experience of young adults diagnosed with cancer and to increase our understanding of how to help them with their caring needs.

BACKGROUND

Being diagnosed with cancer is normally related with an existential crisis. This indicates that the individual cannot avoid thoughts of death, loneliness, guilt, and meaninglessness. In person-centered care, the caretaker should have a holistic view of the person. Professionals must meet the patient´s different needs to strengthen health and well-being for the diagnosed. This approach encourages the traditionally passive patient to become an active consumer who works in partnership with the healthcare provider.

DESIGN

For this study, a content analysis of narratives was conducted, targeting age groups of 20-29 to take part of young adults' experiences.

METHODS

Qualitative analysis of narratives and followed checklist (e.g., COREQ).

RESULTS

During the analyzing phase, two main themes emerged: Interactions with Professionals and Cancer Voyager. In the results, both positive and negative feelings regarding encounters and support received from the professionals were described, this affected the young adults' well-being and their ability to participate during treatments. The young adults felt as being on a journey with no control over which direction the road may take.

CONCLUSION

Outcome of the result shows the importance of making the young adult, one in a team. When working in a person-centered way, patients gain control by owning their own responsibility during treatments.

IMPLICATIONS FOR NURSING PRACTICE

There is a need in nursing education to address existential matters, to make nursing students ready to be approach but such questions in their professional work. Also, we believe that the experienced nurse must be given means to feel confident to handle questions about existential matters. By developing skills in the area of e-Health, collaboration through support groups, and last but not least switching to patient-centered care, we can offer effective and evidence-based care tailored for this population.

Impact of Supervisory Support on Turnover Intention: The Mediating Role of Burnout and Job Satisfaction in a Longitudinal Study

High rates of provider turnover are problematic for our mental health system. Research indicates that supervisory support could alleviate some turnover intention by decreasing emotional exhaustion (a key component of burnout) as well as by increasing job satisfaction. However, the potential mediation mechanisms have not been rigorously tested. Longitudinal data collected from 195 direct clinical care providers at two community mental health centers identified positive effects of supervisory support on reduced turnover intention through reduced emotional exhaustion. Job satisfaction was not a significant mediator. Supervisory support may help mitigate turnover intention through work-related stress reduction.

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.

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

Background

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

Objectives

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

Design

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

Setting

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

Participants

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

Results

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

Limitations

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

Conclusion

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

Future work

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

Funding

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

Staff perceptions of challenging parent-staff interactions and beneficial strategies in the Neonatal Intensive Care Unit

AIM

To characterise neonatal intensive care unit (NICU) staff perceptions regarding factors which may lead to more challenging staff-parent interactions, and beneficial strategies for working with families with whom such interactions occur.

METHODS

A survey of 168 physician and nursing staff at two NICUs in American teaching hospitals inquired about their perceptions of challenging parent-staff interactions and situations in which such interactions were likely to occur.

RESULTS

From a medical perspective, staff perceptions of challenging interactions were noted when infants had recent decompensation, high medical complexity, malformations or long duration of stay in the NICU. From a psychological/social perspective, a high likelihood of challenging interactions was noted with parents who were suspicious, interfere with equipment, or parents who hover in the NICU, express paranoid or delusional thoughts, repeat questions, perceive the staff as inaccessible, are managing addictions, or who require child protective services involvement. Frequent family meetings, grieving opportunities, education of parents, social work referrals, clearly defined rules, partnering in daily care and support groups were perceived as the most beneficial strategies for improving difficult interactions.

CONCLUSION

This study delineates what staff perceive as challenging interactions and provides support for an educational and interventional role that incorporates mental health professionals.

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.

Finding a way forward: a literature review on the current debates around clinical supervision

Nursing research increasingly calls for clinical supervision to support nurses and improve nursing practice. Despite this, clinical supervision is not well established in healthcare organisations. This paper employs a critical interpretive approach to review the clinical supervision literature. The review discusses the current debates and challenges exploring possible ways of moving beyond the current criticisms and limitations in the literature. The review concludes that despite some confusion about the quantifiable outcomes, clinical supervision presents a professionally enriching activity that provides a forum for sharing of knowledge and generation of shared understandings of health care. Through this shared experience it is possible that innovative and creative approaches to health care will be born.

The relationships between attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism in a district health service

The main purpose of this study was to investigate the relationships between attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Staff at one district health service inpatient unit (n = 54) completed surveys on their attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Several moderately large correlations were found between perceiving the patients as feeling punished by seclusion and intrinsic satisfaction (r(s) = -.45, p = .001), and between patients asking to go to the seclusion room and personal accomplishment (r(s) = -.39, p = .002). In general, however, most correlations were small or negligible in size. The influence of nurses on the practice of seclusion was clear, with 72% of participants indicating it was nurses who most often make decisions regarding seclusion. Some participants appear to have a broad interpretation of when seclusion should be used, raising doubts about whether it is being employed solely as a measure of last resort. Given their high level of involvement in seclusions, nurses need to be actively involved in organisation-wide initiatives to reduce the use of this practice.

Implementing clinical supervision for ICU Outreach Nurses: a case study of their journey

INTRODUCTION

Many health services with Intensive Care Units have developed ward liaison programs, managed by Outreach Nurses, to facilitate the transition for patients between the intensive care and general wards. This paper reports a case study of clinical supervision for two Outreach Nurses as they adapted to their new, largely autonomous role in an Australian tertiary hospital.

METHOD

Individual clinical supervision was provided fortnightly to two Outreach Nurses over 12 months by an experienced facilitator, and evaluated using a case study methodology. The Outreach Nurses completed a journal that captured their personal and professional growth and the supervisor also provided a reflective account. An interview was conducted with both Outreach Nurses to evaluate their experiences of clinical supervision.

FINDINGS

Key themes emerging from all the data sources included: respect for clinical supervision and the supervisor; role clarification; understanding and dealing with interpersonal issues; dedicated time for reflection; facing up to issues and letting them go.

CONCLUSION

The Outreach Nurses described the personal and professional benefits of clinical supervision and highlighted how it was successfully implemented for them in a busy clinical environment with limited available resources.

Effective clinical supervision for regional allied health professionals - the supervisee's perspective

Aim. Clinical supervision (CS) for health professionals supports quality clinical practice. This study explored current CS effectiveness for allied health professionals (AHPs) at a regional health service from a supervisee perspective and identified improvements. Method. The Manchester Clinical Supervision Scale (MCSS) was completed by 30 supervisees to determine their perceptions of CS effectiveness. Results. Supervision sessions typically occurred monthly (56.7%) and were one-to-one (86.2%). The mean total MCSS score was 142.83 (s.d. 15.73), greater than the reported threshold score of 136 for effective CS. The mean subscale scores of ‘trust/rapport’ and ‘improved care/skills’ were high, in contrast to the mean subscale scores for ‘finding time’ and ‘personal issues’, which were significantly lower than the other subscales (P < 0.001). Low scores for ‘finding time’ and ‘personal issues’ subscales may be associated with emotional exhaustion and depersonalisation. Conclusions. In this first study evaluating CS for AHPs using the MCSS, CS was reported as being valued and important. However, there is a need for improvement in addressing personal issues that affect work performance and for finding time for CS. As effective CS is an important component of clinical governance by supporting safe and effective healthcare provision, it is vital that CS processes are improved. What is known about the topic? There are reports on clinical supervision (CS) effectiveness for nurses, however, there is limited published information about CS for AHPs. Effective CS may enhance clinical skills, improve patient safety and support reflective practice and is a core component of clinical governance. The MCSS has been used to identify CS effectiveness in nurses; however, there have been no previous reports of its use with AHPs. What does this paper add? This is the first study to use the MCSS for AHPs and identifies areas for improvement in CS, including scheduling and the need to more effectively address personal issues that affect work performance. What are the implications for practitioners? Evaluating the effectiveness of CS in AHPs will lead to improved CS processes and therefore affect the quality of patient care. Effective CS may also affect the wellbeing and job satisfaction for AHPs.

Listening as a method of addressing psychological distress

AIMS

This paper discusses the values of therapeutic listening and ways that emotional difficulties can impact palliative nurses' abilities to provide psychological care.

BACKGROUND

Recent literature indicates that providing psychological care can burden some healthcare professionals including nurses; who may lack the necessary competencies or organizational resources to carry out their roles.

EVALUATION

References drawn from the databases: all EBM reviews, British Nursing INDEX, CINAHL, PSYCH INFO and MEDLINE and EMBASE are discussed.

KEY ISSUES

Psychological care is considered critical to providing holistic care. Yet the literature suggests engaging in such work makes emotional demands on the professionals attempting to carry it out and is associated with psychological difficulties including burnout.

CONCLUSION

Clinical supervision can help reduce the distress caused by emotionally charged situations. Thoughtful clinical supervision can also contribute to safe and effective health care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing would benefit from understanding more about the effects on healthcare professionals of repeated exposure to emotionally charged situations and benefits that clinical supervision can offer to health care.

Impacts of seclusion and the seclusion room: exploring the perceptions of mental health nurses in Australia

The practice of seclusion does not sit comfortably with contemporary Australian mental health policy that emphasizes the provision of mental health services in the least restrictive environment. The negative impact of seclusion on patients and nurses is increasingly being acknowledged. On the other hand, seclusion receives wide support from nurses as a necessary behavior management strategy. The aim of this study was to examine nurses' perceptions of the impact of seclusion and the seclusion room on patients and the changes they would consider to the seclusion room in relation to characteristics of the nurses, including therapeutic optimism, job satisfaction, and burnout. One hundred twenty-three nurses employed in mental health services from Queensland, Australia, participated in this study by completing four self-report scales to measure these attitudes and characteristics. Data were analyzed using descriptive statistics and Pearson's product-moment correlation coefficients. The findings indicate some relationship between the three scales and attitudes to seclusion; however, therapeutic optimism had the strongest link. Participants with higher scores for optimism were more likely to acknowledge the detrimental effects of seclusion and the seclusion room and were more likely to support positive changes to the seclusion room.

Seclusion as a necessary intervention: the relationship between burnout, job satisfaction and therapeutic optimism and justification for the use of seclusion

AIMS

This paper is a report of the study of nurses' attitudes to the use of seclusion. More specifically, the aim was to address the relationship between burnout, job satisfaction and therapeutic optimism and justification of the use of seclusion.

BACKGROUND

Research findings demonstrate that nurses continue to view seclusion as a necessary intervention. Factors that might be associated with attitudes have not been examined.

METHODS

Questionnaires were distributed to nurses employed in inpatient units across eight mental health services in Queensland in 2008. Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory and Minnesota Satisfaction Questionnaires were completed (N = 123). Data analysis involved descriptive statistics and Pearson product-moment correlation coefficients.

RESULTS

Most participants considered certain behaviours particularly those involving harm to self, others or to property as appropriate reasons for the use of seclusion and were consistent with their perceptions of the likely practice on their unit. An association was found between therapeutic optimism and emotional exhaustion (burnout) and justifications for the use of seclusion. Participants with higher optimism scores and lower scores for emotional exhaustion were significantly less likely to support the use of seclusion in specific situations.

CONCLUSIONS

The relationship between therapeutic optimism and emotional exhaustion gives new information that might influence strategies and approaches taken with the aim of reducing seclusion use. Further research is warranted to explore these relationships and their implications.

Scratching beneath the surface: influencing factors on nurses' attitudes toward the use of seclusion

Reducing the use of seclusion is now widely identified as a quality issue for mental health services and reflects recognition of the detrimental impact of seclusion on consumers of services. Despite this, the research evidence suggests that nurses continue to support the use of seclusion in order to maintain a safe environment. The aim of this study was to consider how factors such as Therapeutic Optimism, Job Satisfaction, and Burnout might relate to nurses' attitudes toward seclusion. The Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory, and Minnesota Satisfaction Questionnaires were completed by 123 nurses employed in one of eight participating mental health services. Data analysis included Spearman's rho and independent-samples t-tests statistics. The findings suggested several significant relationships between attitudes toward seclusion and therapeutic optimism, job satisfaction, and burnout. Participants with higher optimism scores, high intrinsic motivation, low emotional exhaustion, and high personal accomplishment were more likely to respond negatively to the use of seclusion. This research enhances our understanding of attitudes toward seclusion and may assist in the development of interventions to influence more positive attitudes.

Availability of role support for nursing students and qualified nurses in Jordan

BACKGROUND

In Jordan there is limited research evidence regarding aspects of role support provided for nurses and a critical analysis for the availability of support mechanisms has yet to be conducted.

AIM

To review the current state of role support offered to student and qualified nurses in Jordan.

CONCLUSIONS

There is marked deficit in support mechanisms provided by political and professional organizations. Role support provided by nursing management is limited to inspecting, directing, controlling and evaluating nurses' work while skill development and personal well-being of nurses are ignored. Nurses are promoted to management positions based on length of service rather than merit. Additionally, there is an apparent dominance of the medical profession in nursing management decisions. These negatively impact the quality of support being provided to nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

There is an urgent need for the development of nursing legislation and regulation which can provide role support for nurses at national level. The provision of managerial training for senior nurses and the development of a system where promotion is based on merit should help nurse managers become proactive. In return this will improve the quality of role support provided to nurses and ultimately promote the provision of high-quality patient care.

A critical review of the nursing shortage in Malaysia

OBJECTIVE

This paper describes and critically reviews steps taken to address the nursing workforce shortage in Malaysia.

BACKGROUND

To address the shortage and to build health care capacity, Malaysia has more than doubled its nursing workforce over the past decade, primarily through an increase in the domestic supply of new graduates.

METHODS

Government reports, policy documents and ministerial statements were sourced from the Ministry of Health Malaysia website and reviewed and analysed in the context of the scholarly literature published about the health care workforce in Malaysia and more generally about the global nursing shortage.

RESULTS

An escalation in student numbers and the unprecedented number of new graduates entering the workforce has been associated with other impacts that have been responded to symptomatically rather than through workplace reform. Whilst growing the domestic supply of nurses is a critical key strategy to address workforce shortages, steps should also be taken to address structural and other problems of the workplace to support both new graduates and the retention of more experienced staff.

CONCLUSION

Nursing shortages should not be tackled by increasing the supply of new graduates alone. The creation of a safe and supportive work environment is important to the long-term success of current measures taken to grow the workforce and retain nurses within the Malaysian health care system.

Strategies for effective on-call supervision for internal medicine residents: the superb/safety model

BACKGROUND

Supervision is central to resident education and patient safety, yet there is little published evidence to describe a framework for clinical supervision. The aim of this study was to describe supervision strategies for on-call internal medicine residents.

METHODS

Between January and November 2006, internal medicine residents and attending physicians at a single hospital were interviewed within 1 week of their final call on the general medicine rotation. Appreciative inquiry and critical incident technique were used to elicit perspectives on ideal and suboptimal supervision practices. A representative portion of transcripts were analyzed using an inductive approach to develop a coding scheme that was then applied to the entire set of transcripts. All discrepancies were resolved via discussion until consensus was achieved.

RESULTS

Forty-four of 50 (88%) attending physicians and 46 of 50 (92%) eligible residents completed an interview. Qualitative analysis revealed a bidirectional model of suggested supervisory strategies, the "SUPERB/SAFETY" model; an interrater reliability of 0.70 was achieved. Suggestions for attending physicians providing supervision included setting expectations, recognizing uncertainty, planning communication, having easy availability, reassuring residents, balancing supervision, and having autonomy. Suggested resident strategies for seeking supervision from attending physicians included seeking input early, contacting for active clinical decisions or feeling uncertain, end of life issues, transitions in care, or help with systems issues. Common themes suggested by trainees and attending physicians included easy availability and preservation of resident decision-making autonomy.

DISCUSSION

Residents and attending physicians have explicit expectations for optimal supervision. The SUPERB/SAFETY model of supervision may be an effective resource to enhance the clinical supervision of residents.

Introducing peer-group clinical supervision: an action research project

Clinical supervision (CS) has been found to be beneficial in the role development of nurses and can contribute to increased job satisfaction and reduced burnout. However, implementing CS can be resource intensive, and there are few accounts of it being implemented in developing countries. Ten psychiatric nurses in Trinidad engaged in an action research project over a 5-month period to develop, implement, and undertake an initial evaluation of a model of peer-group CS for use in routine practice. The participants were involved in undertaking peer-group CS and contributing to monthly focus groups to reflect on the practices and further refine the model. This inexpensive form of CS was perceived by participants to have positive effects on the way they viewed and practiced nursing. An outline of the model and initial evaluation is presented, but further research is necessary to establish the sustainability of the model in practice.

Effects of organizational change on work-related empowerment, employee satisfaction, and motivation

This article reports the results of a longitudinal quantitative study on nurses' views on factors promoting and impeding empowerment and examines the relationship between work-related empowerment and background variables in one hospital. Data were collected using a self-administered questionnaire and analyzed statistically. Nurses gave lowest assessments of promoting factors on the second measurement occasion, a time when the organization was going through major changes. Both job satisfaction and motivation showed a positive relationship with factors promoting empowerment. Organizational changes have a direct effect on the work environment in terms of empowerment and job satisfaction. To cope successfully with changes, special attention must be paid to personnel management. It seems that factors promoting and impeding empowerment can be used to measure effects of organizational changes as well.

Clinical supervision: The way forward? A review of the literature

A discussion of clinical supervision to enhance existing support structures such as preceptorship and mentorship to positively influence the recruitment and retention of newly graduate nurses provides the main focus for this paper. The nursing literature provides evidence for alternative but equally worthy perspectives on clinical supervision. Essential to the successful practice of clinical supervision is the need to ascertain whether it is simply a system to ensure an effective workforce or one that will empower nurses to realise their vision of nursing.

Fully developed burnout and burnout risk in intensive care personnel at a university hospital

We assessed the prevalence of fully developed burnout, burnout risk and the influence of work and employment related factors in five intensive care units at a university hospital. A cross-sectional study was conducted using self-reporting questionnaires for the evaluation of the frequency and intensity of burnout syndrome (Maslach Burnout Inventory) and work and employment related factors. From a total of 320 eligible intensive care personnel, 33 physicians and 150 nurses participated in the study (59% response rate). Applying the process model for burnout, 63 participants (34.4%) were at risk for burnout and another 11 respondents (6.0%) revealed evidence of fully developed burnout (emotional exhaustion > or =4.0 and lack of personal accomplishment < or =4.0). No statistically significant difference in prevalence of fully developed burnout or burnout risk was detected in sub-groups according to age, gender level of training, years of employment and family status. The desire to choose the same profession again was significantly less in respondents with fully developed burnout (P=0.006). The opportunity to regularly attend facilitation was significantly lower for participants with fully developed burnout (P=0.002) compared to participants with no burnout. Fully developed burnout and burnout risk are common in intensive care personnel. Support from facilitators appeared to be an important preventive factor

The Integration of Clinical and Managerial Supervision: A Critical Literature Review

The introduction of a new development review process, the Knowledge and Skills Framework (KSF), has placed a greater demand on occupational therapists within the health service to be more accountable for practice. It has been proposed that the KSF may provide a useful structure for supervision in order to ensure continual development. Therefore, this literature review looked at the appropriateness of addressing both clinical and managerial issues within the supervisory process.

The results indicate that despite many professions being unsure of how best to deliver supervision, there is a common understanding that a structure combining clinical and managerial supervision, such as the KSF, may be useful. It is, however, recommended that the roles of appraiser and supervisor remain separate, because many researchers found conflict within this duality of role as having an impact upon the effectiveness of supervision. It is also recommended that further research be undertaken in order to evaluate formally the effectiveness of integrating the KSF into supervision.