Getting a grip on Safewards: The cross impact of clinical supervision and Safewards model on clinical practice

The Safewards model is used across various mental health settings to reduce incidents of conflict and containment and its efficacy in reducing the use of seclusion and restraint, improving patients' experiences of care, and enhancing safety within clinical settings is well documented (Bowers, Journal of Psychiatric & Mental Health Nursing, 21, 2014, 499). However, there are barriers to successful implementation, including level of staff buy-in (Baumgardt et al., Frontiers in Psychiatry, 10, 2019, 340; Price et al., Mental Health Practice, 19, 2016, 14). This mixed-method study assessed the impact of adopting a Safewards model within a clinical supervision framework in an approach, named Group Reflective integrated Practice with Safewards (GRiP-S), which integrates Safewards theory within the clinical supervision framework. Both quantitative and qualitative data were collected using the questions derived from the Manchester Clinical Supervision Scale -26© (Winstanley & White, The Wiley International Handbook of Clinical Supervision. John Wiley & Sons Ltd, 2014). A total of 67 surveys and eight interviews were completed by nursing staff. Overall, the results showed that the GRiP-S approach improves the implementation of Safewards and nurses' clinical practice. Nursing staff satisfaction with clinical supervision and Safewards improved post GRiP-S pre-GRIP-S- 69.54 (SD 16.059); post-GRIP-S 71.47 (SD 13.978). The survey also identified nursing staff's perception of GRiP-S in the restorative and formative domains of clinical supervision improved. The restorative mean score pre-GRiP-S was 28.43 (SD 5.988) and post-GRiP-S 29.29 (SD 3.951). The formative mean score pre-GRiP-S was 20.10 (SD 5.617) and post-GRiP-S 20.63 (SD 13.978). The qualitative results further explained the satisfaction levels and the changes seen in perception domains. The GRiP-S approach reported (i) improved therapeutic relationships and patient centred care, (ii) improved staff communication and teamwork, (iii) barriers to GRiP-S engagement, and (iv) assistance with the change process. The results indicate that the GRiP-S approach had a positive impact on Safewards delivery and supports ongoing change of practice.

'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.

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.

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.

A randomised controlled trial of clinical supervision: selected findings from a novel Australian attempt to establish the evidence base for causal relationships with quality of care and patient outcomes, as an informed contribution to mental health nursing practice development

This paper reports on selected findings from a novel randomised controlled trial (RCT) conducted in mental health settings in Queensland, Australia. Several national and state reports recently revealed the sub-optimal state of Australian mental health service provision which have direct implications for mental health nursing, including the privately experienced cost of working and coping in these settings. Clinical supervision (CS), a structured staff support arrangement, has shown promise as a positive contribution to the clinical practice development agenda and is now found reflected in health policy themes elsewhere in the world. However, CS is underdeveloped in Australia and the empirical evidence base for the informed implementation of CS, per se, has remained elusive. Within the overall context of a RCT design, therefore, and supplemented by other data collection methods, this large and generously funded study attempted to make an incremental contribution to better understanding this demanding substantive domain. Whilst the substantive insights and theoretical propositions reported here were derived from, and may be limited by, a sub-specialty of nursing and a single geographic location, they were earthed in the personal self-reported experience of those directly involved with a clinical practice innovation. They may resonate with counterparts beyond mental health nursing and Queensland, Australia, respectively, therefore, and may assist in both conceptualising and operationalising CS research, education, management, policy and clinical practice development decision making in the future.

Implementation of Clinical Supervision: educational preparation and subsequent diary accounts of the practicalities involved, from an Australian mental health [corrected] nursing innovation

Set against the backdrop of several inquiry reports about mental health service provision in Australia, the privately experienced cost of working and coping in contemporary mental health settings, remains poorly understood. Clinical Supervision, a structured staff support arrangement, has shown promise as a positive contribution to the clinical governance agenda and is now found reflected in central policy themes elsewhere in the world. However, the concept of Clinical Supervision remains underdeveloped in Australia. The background to a novel randomized controlled trial, currently in progress in Queensland, Australia, is reported elsewhere. This paper reports on the educational preparation for, and subsequent first-hand testimony of the issues faced by, front-line mental health nursing staff engaged in the implementation of Clinical Supervision, under the auspices of the randomized controlled trial. It is argued here that, in advance of quantitative findings becoming available, several challenges emerge from their supplementary and contemporaneous diary accounts of their experience that may confront Clinical Supervision policy makers, educators, managers and clinicians, anywhere in the world, with immediate effect.