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

A systematic review and narrative synthesis of indirect psychological intervention in acute mental health inpatient settings

OBJECTIVES

Psychologists frequently deliver indirect psychological interventions in mental health inpatient settings to support staff to reflect upon and improve their clinical practice. However, research into these interventions is sparse. Therefore, this study aimed to undertake a systematic review and narrative synthesis of the indirect psychological interventions used in mental health inpatient settings.

METHODS

MEDLINE, PsycINFO and Embase were searched for eligible studies and forward-citation searching was undertaken. A narrative synthesis was undertaken to synthesize results. The quality of studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Ten studies were included in the review, and all utilized a small to moderate sample size. We identified five categories of interventions involving a range of methodologies and the studies were assessed to be of good to adequate quality. The most common type of indirect intervention employed was case formulation sessions. Other types of indirect interventions included formal clinical supervision, reflective practice and staff practice-based education sessions. Overall, the utilization of indirect psychological interventions shows promise, particularly case formulation sessions.

CONCLUSIONS

The use of indirect psychological interventions within mental health inpatient settings may have benefits for patient care. However, additional larger scale research is required to further develop the evidence base of indirect interventions for this setting.

Forensic Mental Health Nurses' Experiences of Clinical Supervision

BACKGROUND

Clinical supervision may support forensic mental health nurses with personal and professional growth in a work environment characterized by therapeutic, ethical, and practical challenges.

AIM

The aim of this study was to describe the experiences of forensic mental health nurses participating in a clinical supervision program.

METHODS

Seven forensic mental health nurses and two allied health professionals, working in a high-security forensic mental health hospital, were interviewed regarding their experiences of participating in a clinical supervision program.

FINDINGS

Participants expressed a need for clinical supervision and were motivated to participate in the program. Benefits of clinical supervision experienced by participants included improved communication with their colleagues, being supported in their career development, and developing habits and techniques to reflect on practice issues. Participants described being able to connect with their supervisor, enabled by both trust and confidence in the supervisor's expertise.

CONCLUSION

Staff showed engagement in the clinical supervision process and expressed experiencing positive outcomes related to personal and professional growth and development.

IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE

To support nurses with the forensic mental health context-specific challenges they face, organizations should enable and promote access to clinical supervision. Considerations for forensic mental health organizations to increase uptake and effectiveness of clinical supervision include use of externally based clinical supervisors with adequate skills and experience with providing clinical supervision to clinical staff who work in a secure environment.

Staff perception of case discussion groups on a UK inpatient psychiatric ward: a mixed method service evaluation

BACKGROUND

Staff and patient experiences of inpatient psychiatric wards can be negative, with staff suffering increasingly higher rates of burnout and aggression, and patients dissatisfied with the lack of therapeutic climate. The need for improved support for both has long been identified, yet many group types are ill defined and their effectiveness is unclear. In response, clinical psychologist-facilitated case discussion groups (CDGs) have been implemented across limited wards within an NHS Foundation Trust to develop staff formulation and reflective skills and provide dual peer and formal support.

AIMS

This evaluation aimed to assess staff perceptions of CDG impact on staff outcomes and patient care.

METHODS

Twenty permanent unit staff members of a female acute inpatient ward participated in this mixed method evaluation. Staff were administered a two-part questionnaire. A subset of participants then completed a semi-structured qualitative interview.

RESULTS

CDG were rated extremely positively for both staff and patient care outcomes. Staff recognised increased patient contact, reduced restraint incidents, and higher levels of confidence in their role. Suggested improvements to CDG include a more formal review of action plans.

CONCLUSION

Further research is required to explore patient perceptions of CDG and explore impact across different ward types.

'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.

Occupational Stress in Chinese Higher Education Institutions: A Case Study of Doctoral Supervisors

This qualitative study is intended to explore the factors that contribute to the occupational stress suffered by Chinese doctoral supervisors and the kind of measures needed to effectively address the issue. Through purposive and snowballing sampling, 30 Chinese doctoral supervisors in different disciplines of natural science and social science were selected. A semi-structured interview protocol was used, and the data were analyzed based on grounded theory methodology. Chinese doctoral supervisors experienced varied stressors of nuanced nature, which could be categorized into two core categories, i.e., performance-appraisal-related factors and Ph.D. student-related factors, which were further divided into 18 subcategories and 10 higher-level categories. Chinese doctoral supervisors are under various sources of stress, corroborating with and reinforcing previous research findings in respect to occupational stress worldwide. Through the analysis of the stress triggers, suggestions are presented in regard to what mental health professionals and educational policy makers can do to address the issue of concern for doctoral supervisors.

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.

Overcoming barriers to implementing ward-based psychosocial interventions in acute inpatient mental health settings: A meta-synthesis

BACKGROUND

The culture of acute mental health wards is often dominated by medical models of care despite some patient dissatisfaction with care in these settings and a demand for increased access to psychosocial interventions. Research has found that psychosocial interventions can improve a number of patient and staff outcomes, however, implementation within these settings is often challenging.

OBJECTIVES

The aim of this review was to provide a comprehensive synthesis of the barriers and facilitators to implementing psychosocial interventions on acute wards, in order to develop a list of recommendations for embedding psychosocial interventions within the ward culture in acute settings.

METHODS

Databases were systematically searched using search terms related to acute mental health wards and psychosocial intervention implementation from inception to December 2019. Thirty-nine studies (forty-three papers) that explored the implementation of psychosocial interventions on adult acute mental health wards using qualitative methods met inclusion criteria. Data relating to barriers and facilitators to implementing psychosocial interventions extracted from the results sections of the papers were synthesised using the COM-B model.

RESULTS AND CONCLUSIONS

We conclude that to address barriers to the implementation of psychosocial interventions, services should provide clear information to patients regarding the benefits of engagement, and additional training for staff. A shift in ward culture is required and can be achieved through the recruitment of empathic implementers, together with providing staff with protected time for delivery of psychosocial interventions with clear accountability for intervention delivery through the provision of clearly defined roles.

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.

Recovery-Oriented Reflective Practice Groups: Conceptual Framework and Group Structure

The recovery-oriented reflective practice group (RORPG) is a staff-directed intervention aimed at achieving the recovery-focused transformation of mental health settings. This discussion paper aims to outline and reflect on the conceptual framework and group structure of recovery-oriented reflective practice groups. RORPGs build on conceptualizations of reflective practice, personal recovery, mental health nursing as a relational and reflective practice, and abductive reasoning. Dewey's phases of reflection, together with an understanding of nursing practice as a dynamic process of care, provide a structure for group sessions in which abductive reasoning can be considered a core activity. This paper outlines a sound theoretical foundation and suggests that RORPGs might prove useful for providing a space for learning in practice, informed by both theoretical and practical knowledge.

Reflective practice groups: Are they useful for liaison psychiatry nurses working within the Emergency Department?

BACKGROUND

Liaison psychiatry nurses in Emergency Departments assess and plan onward treatment for individuals, often following self-harm or suicide attempts. These nurses are at high risk of occupational stress. Reflective practice groups may be beneficial, but there is currently no research evaluating this.

AIM

We explored nurses' experiences of attending psychology-led reflective practice groups.

METHOD

Thematic analysis of semi-structured interviews with 13 nurses was undertaken.

RESULTS

Four themes emerged from the data: (i) Sharing and learning; participants discussed how the group provided a platform to share common experiences, express emotions and learn from each other. (ii) Grounding and perspective; participants said the group encouraged reflection on the impact of their work, with a sense of valuing their skills and the difference they make. (iii) Space; participants spoke about the group being a protected, structured and safe space. (iv) Relationships; participants said the group allowed them to support each other and have conversations in a sensitive and non-threatening way. Discussions in the group increased some participants' confidence and self-esteem.

DISCUSSION

Some nurses perceive a range of benefits from participating in reflective practice groups.

IMPLICATIONS FOR PRACTICE

For some mental health nurses reflective practice groups are an acceptable and valued intervention which may reduce burnout.

The deadlock of saying "That is what we already do!" A thematic analysis of mental healthcare professionals' reactions to using an evidence-based intervention

WHAT IS KNOWN ON THIS SUBJECT?: There is a need to shed light on healthcare professionals' reactions to the use of the Guided Self-Determination method in a mental health hospital to better understand and adjust the implementation process of evidence-based practice. Healthcare professionals´ values and beliefs play an important role when implementing evidence-based practice in real-world healthcare settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study identifies opposite positions in mental healthcare professionals: being ready or resistant to change when implementing an evidence-based intervention. The positions are elaborated in four thematic dynamic continuums describing reactions to using the intervention. In addition, this is the first study to explore mental healthcare professionals´ reactions to using the Guided Self-Determination method in a mental health context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When preparing implementation of an evidence-based intervention, it is important to consider adaptation of the intervention, the mental healthcare professionals' acceptability, support from management and participation in supervision. In future research, it is important to consider collecting data from mental healthcare professionals trained in using an evidence-based intervention, however not using it in clinical practice, to understand barriers towards evidence-based practice. ABSTRACT: Introduction Evidence-based interventions are required in mental health nursing to improve quality and outcome for patients. However, there is a need to shed light on professionals' reactions to the use of evidence-based interventions to better understand and adjust the implementation process. Aim To explore mental healthcare professionals´ reactions to using the evidence-based intervention Guided Self-Determination method in the care of inpatients with severe mental illness. Method A qualitative study conducted in relation to an 8 months implementation program. Data collection: 9 qualitative interviews and field notes generated from supervision of the intervention. Results Four themes emerged from a thematic analysis: "The expert becomes novice," "Theory used as a looking glass," "Guided Self-Determination perceived as an interruption" and "Becoming an informer of the impact of GSD." Discussion Using the themes may help leaders or researchers predict or discover the support needed by individual professionals. Implications for practice When preparing implementation of an evidence-based intervention, it is important to consider adaptation and acceptability, as well as support from management and participation in supervision. Finally, it is worth to consider collecting data from trained professionals, who did not use the intervention in practice to understand barriers towards evidence-based practise.

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.

Resistance to group clinical supervision: A semistructured interview study of non-participating mental health nursing staff members

This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditionally been theorized as a supervisee's maladaptive coping with anxiety in the supervision process. The aim of the present study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semistructured interviews with 24 Danish mental health nursing staff members who had been observed not to participate in supervision in two periods of 3 months. Interviews were audio-recorded and subjected to discourse analysis. We constructed two discursive positions taken by the informants: (i) 'forced non-participation', where an informant was in favour of supervision, but presented practical reasons for not participating; and (ii) 'deliberate rejection', where an informant intentionally chose to not to participate in supervision. Furthermore, we described two typical themes drawn upon by informants in their positioning: 'difficulties related to participating in supervision' and 'limited need for and benefits from supervision'. The findings indicated that group clinical supervision extended a space for group discussion that generated or accentuated anxiety because of already-existing conflicts and a fundamental lack of trust between group members. Many informants perceived group clinical supervision as an unacceptable intrusion, which could indicate a need for developing more acceptable types of post-registration clinical education and reflective practice for this group.

Developing and implementing ‘meta-supervision’ for mental health nursing staff supervisees: opportunities and challenges

This paper reports from a study of an intervention aimed at strengthening mental health nursing staff supervision. We developed and tested a short-term group-based meta-supervision intervention as a supplement to usual supervision. The intervention drew on action learning principles to activate and inspire supervisees to develop strategies for influencing their own supervision practices. The core ‘meta-supervisory’ process was organized round participants’ reflections on the possible benefits of supervision, their perceived barriers to realizing the benefits, and the articulation of concrete actions to overcome the barriers. In this paper, we introduce previously reported findings from the study and present two novel supplementary analyses of data from the meta-supervision process. First, we analyse a transcript of an audio recording made during the intervention, which illustrates how supervisees generate empowering psychosocial resources through the group processes. Second, we analyse supervisees’ paraphrased accounts of barriers to effective supervision and their accounts of personal projects to overcome the barriers. Barriers ‘outside’ the supervision setting primarily inspired projects aimed at creating structural change, whereas barriers ‘inside’ the supervision setting inspired projects aimed at creating individual change. The meta-supervision intervention was effective in increasing participation in supervision, but it shared the same problems of resistance and reluctance as often observed in supervision in general. In the discussion, we compare our ‘bottom-up’ approach to activating supervisees and implementing supervision practices with ‘top-down’ approaches. The meta-supervision intervention illustrated the importance of engaging supervisees in their own supervision and suggested how it can have both individual and organizational benefits.

The development of peer reflective supervision amongst nurse educator colleagues: An action research project

This action research study developed the use of peer reflective supervision (PRS) amongst eight nurse educators contributing to an undergraduate Adult Nursing programme at a UK University. During the academic year (2013-14), nurse educator co-researchers met for an introductory workshop and then met regularly in pairs to facilitate each other's reflection. This provided an opportunity for nurse educators to reflect on identified issues linked to their role with a facilitative peer. Educators met three additional times in a Reflexive Learning Group (RLG), to gather data on their use of PRS. Audio-recordings from the RLGs were transcribed and analysed using Norton's (2009) thematic analysis framework. Co-researchers iteratively validated the data and an external validation group critically viewed the evidence. Overall, seven themes were generated from the three research cycles. These were: PRS as a Valuable Affirming Experience; Time Issues; Facilitation- Support, Trust and Challenge; Developing a Flexible 'Toolbox'; To Write or Not to Write; Drawing on Literature; and Requirement for Action. Findings add new evidence regarding use of a flexible toolbox of resources to develop reflection and offer practical guidance on the development of PRS. Nurse educators often experienced similar concerns, and a facilitative supervision structure allowed co-researchers to positively explore these. Recognition of work pressures and requirement for time and space for reflection was highlighted, particularly regarding writing, and exploring the literature, to develop critical analysis of experiences. The importance of action as part of the reflective process was emphasised. Co-researchers reported positive personal change as well as the opportunity to highlight issues through their reflection for further action within the organisation. The study adds constructive evidence for the use of reflection to explore professional work, make sense of experiences and develop positive action. It has transferability to a wider international audience interested in the development of reflection amongst colleagues and the use of insider research techniques to challenge and develop practice.

Exploring Organizational Barriers to Strengthening Clinical Supervision of Psychiatric Nursing Staff: A Longitudinal Controlled Intervention Study

This article reports findings from a longitudinal controlled intervention study of 115 psychiatric nursing staff. The twofold objective of the study was: (a) To test whether the intervention could increase clinical supervision participation and effectiveness of existing supervision practices, and (b) To explore organizational constraints to implementation of these strengthened practices. Questionnaire responses and registration of participation in clinical supervision were registered prior and subsequent to the intervention consisting of an action learning oriented reflection on staff's existing clinical supervision practices. Major organizational changes in the intervention group during the study period obstructed the implementation of strengthened clinical supervision practices, but offered an opportunity for studying the influences of organizational constraints. The main findings were that a) diminishing experience of social support from colleagues was associated with reduced participation in clinical supervision, while b) additional quantitative demands were associated with staff reporting difficulties finding time for supervision. This probably explained a negative development in the experienced effectiveness of supervision. It is concluded that organizational support is an imperative for implementation of clinical supervision.

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.

Receiving group clinical supervision: a phenomenological study

This study examined the process of group supervision as experienced by one team of biofeedback therapists working in the south of England. A phenomenological study was undertaken to examine the team's perceptions of attending group supervision over time. Ten one-to-one in-depth interviews were conducted, six of which were with biofeedback therapists currently receiving supervision, three with nurses who used to receive this supervision and one interview with the supervisor. A four-stage model detailing how supervisees' experiences changed as a consequence of continued group supervision was developed. Study data revealed how this process allowed the biofeedback therapists to examine their clinical interventions and align their approach and perspective alongside other team members. This was a valuable and safe way of learning 'on the job' for the newer members of the team. The opportunity for free-thinking and reflection on practice supported clinical decision-making and therapeutic nursing. The more experienced supervisees demonstrated how their continued attendance of the group supervision sessions not only confirmed their expertise in role, but also facilitated their colleagues' development, which enhanced role satisfaction. The data also indicated some of the essential supervisory features of this process.

Developing a manual for strengthening mental health nurses' clinical supervision

In this article, we report findings from a study aimed at developing the content and implementation of a manual for a research-based intervention on clinical supervision of mental health nursing staff. The intervention was designed to strengthen already existing supervision practices through educational preparation for supervision and systematic reflection on supervision. The intervention consists of three sessions and was implemented on two groups of mental health hospital staff. We present an outline of the manual and explain how the trial sessions made us adjust the preliminary manual. The effects of implementing the manual will subsequently be analysed in an independent randomised controlled trial.

Translation of the Manchester Clinical Supervision Scale (MCSS) into Danish and a preliminary psychometric validation

A central challenge for empirical research of clinical supervision is how to measure the effectiveness of clinical supervision. The Manchester Clinical Supervision Scale (MCSS) measures supervisees' perception of the effectiveness of clinical supervision. The aims of this paper were to account for the translation of the MCSS from English into Danish and to present a preliminary psychometric validation of the Danish version of the scale. Methods included a formal translation/back-translation procedure and statistical analyses. The sample consisted of MCSS scores from 139 Danish mental health nursing staff members. The total MCSS score had good internal consistency, but the analyses identified a number of reliability and consistency issues. The results were compared with other translations of the MCSS and with the reduced version of the MCSS, the MCSS-26. The discussion indicated that MCSS theoretically refers to a broad conception of supervision, which includes supervision practices ranging from highly formalized events to more frequent ad hoc sessions. The MCSS's intention to measure perceptions of supervisees from this variety of practices may be problematic, and it is suggested that a further reduction of the type of practices MCSS currently aims at measuring could be beneficial.

Evaluation of the Manchester clinical supervision scale: Norwegian and Swedish versions

AIM

To develop Norwegian and Swedish versions of the Manchester Clinical Supervision Scale (MCSS) and to test and verify its hypothesized seven-factor structural model.

BACKGROUND

Nurse managers are responsible for upholding and ensuring quality of care as well as for maintaining staff competence, thus safeguarding the standard of care.

METHODS

The research process included a translation-back-translation procedure with monolingual and bilingual tests in addition to psychometric evaluation. The sample consisted of 150 student and registered nurses (RNs) from Norway and Sweden, and confirmatory factor analysis was performed.

RESULTS

The translated versions did not exhibit satisfactory validity and reliability. The confirmatory factor analysis failed to show a good model fit. Low α-values were revealed except for factors 1, 2, 3 and 7. The most important factors of the MCSS were Trust/Rapport, Supervisor advice/Support, Improved care/Skills and Reflection.

CONCLUSION

Translation of an instrument for cross-cultural nursing research is important, although there are methodological limitations associated with construct validity. IMPLICATION FOR NURSE MANAGERS: Instruments for the evaluation of nursing care are necessary in order to formulate strategies at a managerial level. Nurse managers who encourage nurses to attend supervision promote professional development and enhance patient safety.