Clinical supervision for mental health nurses in Northern Ireland: formulating best practice guidelines

Interprofessional supervision among allied health professionals: a systematic scoping review

Clinical supervision typically occurs between clinicians who are trained in the same discipline, and this assumption is present across much of the relevant literature. However, the use of interprofessional supervision (IPS), wherein clinicians do not share the same discipline, has increased in recent years. As IPS increases in usage, it is key that the implications of this approach are explored. In order to map the existing evidence, a scoping review was conducted to explore what is known about the use of IPS across five allied health professions (psychology, speech and language therapy, occupational therapy, physiotherapy and social work). A systematic literature search of four electronic databases was conducted, with 27 articles meeting the inclusion criteria. The data were analyzed using thematic synthesis. Six key themes were identified relating to factors impacting the appropriateness of IPS, necessary steps in the IPS process, and impacts of IPS for clinicians. Limited application of standardized tools and theoretical frameworks within the existing research was highlighted. The findings identified within this review present a broad overview of the existing research relating to IPS, which can be used to inform future research in this area.

The Definitions and Conceptualizations of the Practice Context in the Health Professions: A Scoping Review

INTRODUCTION

Health care professionals work in different contexts, which can influence professional competencies. Despite existing literature on the impact of context on practice, the nature and influence of contextual characteristics, and how context is defined and measured, remain poorly understood. The aim of this study was to map the breadth and depth of the literature on how context is defined and measured and the contextual characteristics that may influence professional competencies.

METHODS

A scoping review using Arksey and O'Malley's framework. We searched MEDLINE (Ovid) and CINAHL (EBSCO). Our inclusion criteria were studies that reported on context or relationships between contextual characteristics and professional competencies or that measured context. We extracted data on context definitions, context measures and their psychometric properties, and contextual characteristics influencing professional competencies. We performed numerical and qualitative analyses.

RESULTS

After duplicate removal, 9106 citations were screened and 283 were retained. We compiled a list of 67 context definitions and 112 available measures, with or without psychometric properties. We identified 60 contextual factors and organized them into five themes: Leadership and Agency, Values, Policies, Supports, and Demands.

DISCUSSION

Context is a complex construct that covers a wide array of dimensions. Measures are available, but none include the five dimensions in one single measure or focus on items targeting the likelihood of context influencing several competencies. Given that the practice context plays a critical role in health care professionals' competencies, stakeholders from all sectors (education, practice, and policy) should work together to address those contextual characteristics that can adversely influence practice.

The Experiences of Psychiatric Mental Health Nurse Practitioners with Clinical Supervision in South Korea: A Grounded Theory Approach

Clinical supervision (CS) helps improve expertise and job satisfaction in nursing staff, but its grounded research is limited. This study was conducted to derive a grounded theory based on the lived experiences of psychiatric mental health nurse practitioners (PMHNPs) in clinical supervision. Data were collected from January to April 2018 through in-depth unstructured interviews with 19 PMHMPs. Supervision of mental health nurses was necessary because of the "lack of ability to integrate theory and practice" and "difficulty working alone". The "poor supervision system" has been strengthened. The nurses used strategies such as "asking for help", "intensive training and sharing with the supervisor", "modeling of the supervisor and developing competencies", "continuing self-reflection and learning", and "participating in professional activities", according to the level of "personality characteristics", "institutional supervision policy", and "relationship with the supervisor". Consequently, the core objective of "supporting each other and becoming healthcare experts" was achieved. These findings can be used as a basis for education, practices, research, and policy development of mental health nursing. This study highlights areas for policy improvement to ensure that high-quality mental health nursing can be achieved through appropriately targeted CS.

'Barriers to overcoming the barriers': A scoping review exploring 30 years of clinical supervision literature

Aims/Questions

To explore the barriers and facilitators to nurses accessing clinical supervision; explore the barriers and facilitators to organizations implementing clinical supervision and capture what skills nurses require to facilitate clinical supervision.

Design

Scoping review of peer‐reviewed research and grey literature.

Data sources

CINAHL, Medline, PsychINFO and Scopus were searched for relevant papers published between 1990 and 2020. Google, Google Scholar, OpenGrey & EThOS were used to search for grey literature.

Review Methods

PRISMA‐ScR guidelines were used during the literature review process. Eighty‐seven papers were included, and data were extracted from each paper using a standardized form. Data synthesis was undertaken using Seidel's analytical framework.

Results

Five themes were identified: Definitions and Models, (Mis) Trust and the Language of Supervision, Alternative Parallel Forums and Support Mechanisms, Time and Cost and Skills required.

Conclusion

Since its inception in the 1990s, clinical supervision has long been regarded as a supportive platform for nurses to reflect on and develop their practice. However, this review highlights that despite an awareness of the skills required for nurses to undertake clinical supervision, and the facilitators for nurses to access and organizations to implement clinical supervision, there have been persistent barriers to implementation. This review identifies these persistent factors as ‘barriers to overcoming the barriers' in the clinical supervision landscape. These require critical consideration to contribute towards moving clinical supervision forward in the spirit of its original intentions.

Impact

This review progresses the debate on clinical supervision through critically analysing the barriers to overcoming the barriers. To this end, the review is designed to stimulate critical discussions amongst nurses in different clinical spaces and key stakeholders such as policy makers and regulatory bodies for the nursing profession.

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.

Developing allied health professional support policy in Queensland: a case study

INTRODUCTION

Evidence suggests that professional support for allied health professionals contributes to improved clinical practice, better client outcomes, enhanced workplace satisfaction, increased workplace morale and better clinical governance within organizations. Despite these benefits, the uptake of formal professional support is surprisingly low and implementation often ad hoc. Further, research investigating the development, evaluation and outcomes of implementing policy to establish such support is limited.

CASE DESCRIPTION

Queensland Health has developed an organization-wide approach to supporting allied health professionals through a Professional Support Policy and guidelines. The processes of development, implementation and the evaluation framework of this State-wide Professional Support Policy are described. An evidence-based Professional Support Policy that is structured, collaborative and well evaluated will have benefits for allied health professions. However, policy introduction cannot occur in isolation. Current practice does not follow current evidence in the area of professional support implementation. This study describes a current practice baseline for participation prior to the mandating of such a policy. There is a need for improvements in participation rates, documentation and capacity building.

CONCLUSIONS

A workforce policy with broad scope should increase the access to, and consistency of, professional support to allied health practitioners. Such policy should facilitate a higher quality clinical practice, better client outcomes, enhanced workplace satisfaction and morale. It may also maximize the recruitment and retention of allied health professionals. Mandating policy should see participation commensurate with that policy. A future step will be a Post Policy Implementation Review to determine the success and effectiveness of the Professional Support Framework within Queensland Health.

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

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

Genetic counseling supervisor competencies: results of a Delphi study

Clinical supervision is a critical component of genetic counseling student preparation, yet empirically-determined competencies for genetic counseling supervisors are lacking. In this study a modified, two-round Delphi method was used to gain consensus about important genetic counseling supervisor knowledge, characteristics, and skills. Program directors and assistant directors of American Board of Genetic Counseling accredited genetic counseling programs in North America (N = 33) were invited to participate and to recruit three experienced supervisors. Seventy-four individuals completed Round 1 and, of these, 61 completed Round 2. Approximately two-thirds were clinical supervisors from prenatal, pediatrics, cancer, and adult clinics; one-third were program directors. Participants rated the importance for genetic counseling supervisors of 158 items derived from supervision literature in allied health professions. They rated 142 items (89.9 %) as highly important. Content analysis of these items yielded six supervisor competency domains: Personal traits and characteristics; relationship building and maintenance; student evaluation; student centered supervision; guidance and monitoring of patient care; and ethical and legal aspects of supervision. The results provide a basis for training genetic counseling supervisors and for further research to refine and validate supervisor competencies.

A rationale for a clinical supervision database for mental health nursing in the UK

Clinical supervision (CS) is regarded as a valuable resource for mental health nursing. While there is considerable anecdotal reports of its implementation throughout the UK, these attempts are not without difficulty. A common tension reported in the literature relates to its provision being more akin to managerial supervision within a line-management hierarchy which jars with its original intention and spirit. This paper will provide a discussion on the implementation of CS in mental health nursing in the UK, beginning with its suggested importance for the discipline. Following on from this, the rationale for a CS database and description of one NHS Board's attempts at developing a resource, initially focusing on clinical supervisors of psychological therapies, will be presented.

Quality allied health clinical supervision policy in Australia: a literature review

Clinical supervision is presented as a complex set of skills that may broadly apply to any and all allied health professions. However, it is also noted that a clear understanding of clinical supervision and how to implement it in allied health is currently lacking. It is argued that there is a need to reflect upon current approaches to clinical supervision amongst allied health professionals and to gain a shared understanding about what supervision involves, what effective supervision is, and what effective implementation of clinical supervision might look like. By gaining an understanding of what high quality clinical supervision is and how it is best put into practice, it is anticipated that this will form the first step in developing an understandable and useful universal supervision policy for all allied health professionals. What is known about the topic? Clinical supervision is important because it improves quality of care for clients and it may also improve staff satisfaction and retention rates and clinical governance for organisations. There is a clear need for a well-articulated supervision policy in allied health as there is currently no comprehensive and universally accepted supervision policy for this group of health professionals. What does this paper add? This literature review argues that if there is no clear supervision policy that is endorsed at a whole of health level there is a risk that disparate, haphazard, and poorly coordinated approaches to supervision may result in poor quality of supervision provision. Much of the recent literature is profession-specific; however, this paper contends that there are many possible reasons for collaboration in establishing clinical supervision in allied health. The possible barriers to implementing a universal policy are also examined. What are the implications for practitioners? This literature review will help practitioners understand the complex issues that inform the clinical supervision process and particularly those factors that affect the delivery of an excellent quality of supervision. This knowledge will help them to assess the quality of supervision they receive and provide, and may also contribute to motivation to work with colleagues to develop meritorious supervision skill.

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

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

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

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

Mental health nursing students' experience of stress: burdened by a heavy load

This paper reports research outcomes of a study into personal stress experienced by mental health student nurses undertaking a diploma programme in Ireland. It uses a phenomenological research approach. The sample was purposive and involved in-depth interviews with six students. The purpose of the study was to contribute to the knowledge of the impact of personal life stressors. Findings from this study focus on the following themes: event, meaning, effects, ability to move beyond the stress, influence on life and constraints and demands. Key points arising are that the stress experience does impact students' internal and external worlds, potentially lessening functioning and inhibiting growth and development. This paper presents student narratives that offer insights into their inner worlds, providing true accounts of the essence of stress for them. This knowledge has implications for lecturers, personal tutors, nurse educationalists and nursing curricula, highlighting need for more proactive approaches to the provision of guidance on professional support for students and staff. Insights derived from this study are relevant not only to mental health nurse education but also to academic staff delivering professional education programmes to healthcare practitioners in a variety of settings.

Psychiatric nurses' descriptions of women with postpartum psychosis and nurses' responses--an exploratory study in Sweden

Postpartum psychosis is the most serious type of psychiatric illness related to childbirth. This interview study with nine psychiatric nurses in Sweden explored psychiatric nurses' descriptions of women with psychosis occurring in the postpartum period and nurses' responses when providing care to these women. Content analysis was used to analyze the data. The nurses described delusions, disconnection, aggression, changed personality, self-absorption, insomnia, chaos, quietness, suicidal ideation, and 'strange eyes.' The description of strange eyes noted by the nurses has not been found in the literature, warranting further investigation. When providing care, the nurses responded with sadness, sympathy, empathy and compassion, discomfort, anger, anxiety, and happiness. These findings underscore the importance of nurses recognizing their negatively charged emotions which could interfere with providing compassionate and effective nursing care to this population.