A Paradigm Shift in Nurse Specialist Clinical Supervision-Implementation of a Competence Program

Clinical supervision experience of nurses in or transitioning to advanced practice: A systematic review

AIMS

To systematically explore the clinical supervision (CS) experience for nurses transitioning to advanced practice.

DESIGN

A qualitative systematic review using Joanna Briggs Institute meta-aggregation following an a priori protocol published on PROSPERO (CRD42023426658).

DATA SOURCES

Qualitative studies obtained from Medline, CINAHL, PsycINFO, Scopus, Emcare and ERIC databases and ProQuest dissertations and theses for peer-reviewed, published and unpublished studies from inception to July 2023.

REVIEW METHODS

Two authors conducted data screening and abstraction. Quality was appraised using the Critical Appraisal Skills Programme tool and reporting followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist for systematic reviews.

RESULTS

Sixteen studies contributed to five synthesized findings: CS that is beneficial requires structure and commitment, trusting relationships are foundational for learning, lifting burdens and preventing burnout, learning through reflection, critical thinking and feedback and barriers to CS.

CONCLUSIONS

This review provides a meaningful exploration of CS to support nurses transitioning to advanced practice. Well-structured supervision offers a safe space to share work-related concerns and develop an advanced practitioner identity. Sharing experiences helps alleviate work-related burdens and reduce professional isolation and burnout.

IMPLICATIONS FOR THE PROFESSION

Peer-support networks are vital for successful transition to advanced practice.

IMPACT

This review highlighted the impact of effective supervisory relationships in forming professional identity and possible links with nursing retention.

PUBLIC CONTRIBUTION

No direct patient contributions are included as it forms part of a research degree.

Pass or fail: Teachers' experience of assessment of postgraduate critical care nursing students' competence in placement. A qualitative study

BACKGROUND

Learning in placement is essential to postgraduate critical care nursing students' education. Assessment of students' competence in placement is important to ensure highly qualified postgraduate critical care nurses. The placement model applied in Norway involves students being assessed by a preceptor in practice and a teacher from the university. The teacher has a more distant role in placement, and the aim of this study was to explore how the teachers experience the assessment of postgraduate critical care nursing students' competence in placement. Additionally, to explore the content of assessment documents used for postgraduate critical care nursing placement education in Norway.

METHODS

This study has a qualitative design with main data collection from individual interviews with 10 teachers from eight universities and colleges in Norway. Additionally, we performed a document analysis of assessment documents from all 10 universities and colleges providing postgraduate critical care nursing education in Norway. We followed the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

The teachers experienced the assessment of postgraduate critical care nursing students' competence in placement as important but complex, and some found it difficult to determine what critical care nursing competence is at advanced level. A thematic analysis resulted in one main theme: "Teacher facilitates the bridging between education and practice." Furthermore, three themes were identified: "Assessment based on trust and shared responsibility"; "The teacher's dual role as judge and supervisor"; and "A need for common, clear and relevant assessment criteria".

CONCLUSIONS

Teachers have a key role in placement as they contribute to the bridging between education and practice by providing valuable pedagogical and academic input to the assessment process. We suggest that more teachers should be employed in joint university and clinical positions to enhance the collaboration between practice and education. Clear and relevant assessment criteria are essential for providing assessment support for both students and educators. Education and practice should collaborate on developing assessment criteria. Further, there is a need to collaborate on developing, both nationally and internationally, common, clear, relevant and user-friendly assessment tools.

Experiences using an instrument for non-technical skills in nurse anaesthesia education: a focus group study

BACKGROUND

Although there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice.

METHODS

This study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach.

RESULTS

Six categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants' experiences with using the instrument: Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour. Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation. Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance.

CONCLUSION

Increased awareness of non-technical skills when using Nurse Anaesthetists' Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists' Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student's learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments.

The operating room as a learning arena: Nurse anaesthetist and student nurse anaesthetist perceptions

AIM

To examine which competencies mentors and student nurse anaesthetists perceive as important in a clinical anaesthesia education practice.

BACKGROUND

Mentoring during clinical placement in the operating room can be challenging from the viewpoint of both a nurse anaesthetist and their students. The operating room is a work environment with many restrictions, and the nurse anaesthetist's work requires prompt decisions and actions. Simultaneously, the mentor is tasked with guiding and supporting the student.

METHOD

A qualitative approach including two focus group interviews was used. The analysis was conducted using systematic text condensation. The COREQ checklist for qualitative studies was applied.

RESULT

The analysis yielded two main categories, including two sub-categories for each. The first, "Mentoring in the operating room," contained sub-categories "Application of knowledge and expectations" and "Mentoring experiences," and the second, "Creating a good climate for learning," contained sub-categories "Impact on mentoring: human factors" and "Impact on mentoring: obstacle factors." The mentor's knowledge of human relationships and learning strategies emerged as an important factor with the potential to influence the students' learning and self-confidence. Another valuable consideration was the ability to give constructive feedback, from the perspective of both. However, production pressure was a negative factor for effective knowledge transition.

CONCLUSIONS

The ability to give constructive feedback and having an awareness of one's own attitude-which should ideally be positive and inclusive-are crucial mentoring skills. Mutual expectations must be clearly communicated before the clinical placement period, including learning assumptions, a progression plan and learning outcomes. This will facilitate the planning and help to direct the optimal course of learning.

IMPLICATIONS FOR CLINICAL PRACTICE

This study highlights that an awareness of the student's vulnerability and the mentor's pedagogical competence and learning strategy are crucial factors to take into account.