Practice nurses and their 'lived experience' of clinical supervision

Models of clinical supervision of relevance to remote area nursing & primary health care: A scoping review

INTRODUCTION

Nurses in remote primary health care settings work in difficult conditions, in isolated and disadvantaged communities, and often must work beyond their scope to provide advanced assessments and treatments to support the community. Therefore, remote area nurses require support to develop their skills and knowledge to work safely within their full scope of practice. Clinical supervision is widely used in health professions for this purpose; however, models of supervision for nursing have not been implemented or evaluated within remote primary health care settings.

OBJECTIVE

The purpose of this study was to search the literature to source suitable clinical supervision models that could pertain to the remote area nursing context.

DESIGN

An initial search of the literature found no clinical supervision models developed for remote or isolated practice nurses so a scoping review was conducted searching for publications related to advanced practice generalist health practitioners in primary health care, including practice nurses, nurse practitioners and general practitioners. This was seen as a suitable substitute because the phenomena of interest were the model of supervision rather than the specific skills or knowledge being developed.

FINDINGS

The scoping review search yielded 251 articles from 5 journal databases of which 11 articles met the inclusion criteria. Each clinical supervision model was described and synthesised using qualitative description. The 11 models of clinical supervision had differing formats including; individual and group clinical supervision, in-person, telephone, medical records review and video case study.

DISCUSSION

Whilst several models were described in the literature, none were directly transferrable to the remote area context. The absence of supervision for cultural safety was significant. There was a variety of modes including face-to-face, virtual, individual and group proposed. Cultural considerations were lacking in all of the models.

CONCLUSION

Our study recommends a hybrid clinical supervision model suitable for consultation and validation through pilot testing with remote area nurses. There is potential for this model to be used globally in isolated contexts due to the option of virtual participation.

A rapid review of the impact of COVID-19 on clinical supervision practices of healthcare workers and students in healthcare settings

AIMS

To synthesize available data on the impact of the COVID-19 pandemic on clinical supervision practices of healthcare workers and students in healthcare settings.

DESIGN

A quantitative rapid review of the literature.

DATA SOURCES

A search of MEDLINE, Embase, PsycINFO, the Cochrane Library and Scopus for English language papers published between December 2019 (initial onset of the pandemic) to March 2021.

REVIEW METHODS

Using the World Health Organization and Cochrane guidelines for rapid reviews, following an identification of relevant papers and data extraction, a narrative synthesis approach was used to develop themes.

RESULTS

Eight studies met the inclusion criteria. Four themes identified from data synthesis were nature and extent of disruptions to clinical supervision, unmet need for psychological support, supervisors also need support and unpacking telesupervision. Findings highlight the extent and nature of disruption to clinical supervision at the point of care. Further information on factors that facilitate high-quality telesupervision have come to light.

CONCLUSION

The COVID-19 pandemic has placed tremendous burden on healthcare workers compromising their own health and well-being. It is essential to restore effective clinical supervision practices at the point of care, so as to enhance patient, healthcare worker and organizational outcomes into the post-COVID-19 pandemic period.

IMPACT

This review has provided initial evidence on the adverse impacts of the COVID-19 pandemic on clinical supervision of healthcare workers and students at the point of care. Available evidence indicates the urgent need to restore effective and high-quality clinical supervision practices in health settings. The review has highlighted a paucity of studies in this area, calling for further high-quality studies.

Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review

OBJECTIVE

To review the impact of clinical supervision of post-registration/qualification healthcare professionals on healthcare organisational outcomes.

BACKGROUND

Clinical supervision is a professional support mechanism that benefits patients, healthcare professionals and healthcare organisations. Whilst evidence is growing on the impact of clinical supervision on patient and healthcare professional outcomes, the evidence base for the impact of clinical supervision on organisational outcomes remains weak.

METHODS

This review used a convergent segregated approach to synthesise and integrate quantitative and qualitative research findings, as per the Joanna Briggs Institute's recommendations for mixed methods systematic reviews. Databases searched included CINAHL, Embase, PubMed, PschINFO, and Scopus. Whilst a narrative synthesis was performed to present the findings of the quantitative and qualitative studies, the evidence from both quantitative and qualitative studies was subsequently integrated for a combined presentation. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Thirty-two studies including 27 quantitative, two qualitative and three mixed methods studies, were included in the review. The results of the quantitative analysis showed that effective clinical supervision was associated with lower burnout and greater staff retention, and effective supervisor was associated with lower burnout and greater job satisfaction. Qualitative findings showed that healthcare professionals believed that adequate clinical supervision could mitigate the risk of burnout, facilitate staff retention, and improve the work environment, while inadequate clinical supervision can lead to stress and burnout. The evidence from quantitative and qualitative studies were complementary of each other.

CONCLUSION

Clinical supervision can have a variable effect on healthcare organisational outcomes. The direction of this effect appears to be influenced by the effectiveness of both the clinical supervision provided and that of the clinical supervisor. This highlights the need for organisations to invest in high quality supervision practices if maximal gains from clinical supervision are to be attained.

Impact of clinical supervision of health professionals on organizational outcomes: a mixed methods systematic review protocol

OBJECTIVE

The objective of this review is to develop an aggregated synthesis of qualitative and quantitative reviews to derive recommendations for policy and practice relevant to clinical supervision (CS).

INTRODUCTION

Clinical supervision is a process where supervisors and supervisees engage in guided evaluation and reflection on current practice to enhance future practice. Recent studies have demonstrated the positive impact of CS on patient outcomes; however, the impact of CS on organizational outcomes is less clear. Therefore, this review will investigate organization outcomes and how health practitioners experience and view CS.

INCLUSION CRITERIA

This review will consider quantitative and qualitative studies on health professional supervisees in nutrition and dietetics, occupational therapy, physiotherapy, psychology, podiatry, social work, speech pathology and exercise physiology in hospitals and community settings. The quantitative component will include studies on the effects of CS based on staff retention and recruitment, intent to stay, intent to leave, job satisfaction and quality of work life, burnout and absenteeism. The qualitative component will consider studies that explore health professional supervisees' experiences on CS related to organizational outcomes.

METHODS

CINAHL, Embase, PubMed, PsycINFO, PEDro and Scopus will be searched for studies published in English, without a date limit. Both quantitative and qualitative studies will be screened for inclusion and critically appraised for methodological quality, and both types of data extracted using JBI tools for mixed methods systematic reviews. A convergent segregated approach to synthesis and integration will be used. The findings of each single method synthesis will be configured according to JBI methodology.

From new vistas to life lines: psychologists' satisfaction with supervision and confidence in supervising

This study aimed to provide the first detailed survey of Irish psychologists' supervision practices as well as to identify what is related to satisfaction with supervisory support and to confidence in providing supervision. An online survey was distributed nationwide to Irish psychologists. Participants were mostly clinical and counselling psychologists. Three-quarters of the participants constituted 51% of the total population of Irish health service psychologists, the remainder working in various non-health service settings. The results showed that most Irish psychologists attend supervision but at a low frequency, typically once monthly. One-third were dissatisfied with their supervision, greater satisfaction being related to having more frequent clinical supervision and having external individual clinical supervision. Having a safe and trustworthy relationship with supervisors was a dominant issue, and two-thirds of psychologists wanted separation of their clinical and line management supervision. Although 70% were supervisors, only 40% were confident in their supervisory skills and just 16% had formal supervisor training. Independent predictors of supervisory confidence were experience as a psychologist, having formal supervisor training, experience as a supervisor and confidence as a therapist. A novel finding was that longer experience of personal therapy was related to greater confidence as a supervisor. This study indicates the need for access to more frequent clinical supervision to be facilitated for psychologists and for there to be clear separation of line management and clinical supervision. It is also essential that more resources are put into training supervisors.

KEY PRACTITIONER MESSAGE

While most psychologists are engaged in supervision, frequency of attendance is low, with more satisfied psychologists having more frequent supervision. Most psychologists want separation of their clinical and line management supervision and have a preference for external supervision, safe and trustworthy relationships with supervisors being their primary concern. Only 16% of psychologists had formal training in supervision but having such training significantly contributed to greater confidence as a supervisor, indicating an urgent need to provide more supervisor training for psychologists.

Maximising psychiatric nurses' contribution to interdisciplinary working

Internationally, the deinstitutionalization of psychiatric care has resulted in expanded roles for mental health nurses within a community interdisciplinary team setting. This presents an opportunity for mental health nurses to improve service delivery. This opportunity also results in a more empowered nursing team. This article identifies change issues within one community psychiatric nursing team and the team's contribution to an improved service delivery where service users can avail of same day assessment for crisis referrals, a reduction in waiting times for assessment and co-ordinated delivery of care with an identified key worker utilizing a recovery model philosophy.

Working through grief and loss: oncology nurses' perspectives on professional bereavement

PURPOSE/OBJECTIVES

To determine facilitators and barriers to managing patient loss from the combined perspectives of oncology nurses and to extract essential components of a supportive intervention.

RESEARCH APPROACH

Qualitative, descriptive.

SETTING

The comprehensive National Cancer Institute-designated cancer center of a mid-Atlantic university teaching hospital.

PARTICIPANTS

34 nurses from inpatient and outpatient adult and pediatric oncology units.

METHODOLOGIC APPROACH

Focus groups were held with oncology staff nurses to identify challenges regarding work-related bereavement, current support for managing grief and loss, and how to support interpersonal functioning and resiliency.

MAIN RESEARCH VARIABLES

Work-related bereavement, bereavement support, and interventions and management strategies for bereavement and loss.

FINDINGS

Two primary themes emerged: dimensions of work-related loss and working through bereavement. Participants also provided many concrete suggestions for the creation of a supportive self-care environment.

CONCLUSIONS

Support issues were numerous, multilevel, and varied. However, addressing those concerns can improve job satisfaction and decrease compassion fatigue. The findings lay the foundation for appropriate interventions to assist nurses in managing those situations.

INTERPRETATION

Administrators, managers, and individuals interested in furthering the multifaceted goals of oncology care, including nurses themselves, are challenged to create and maintain mutually supportive environments for providing optimal care to patients and families.

Refractory suffering: The impact of team dynamics on the interdisciplinary palliative care team

Objective:

This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering.

Method:

Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews.

Results:

In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness.

Significance of results:

The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.

Practice nursing in Australia: A review of education and career pathways

BACKGROUND

Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia.

METHODS

Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses.Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer.

RESULTS

Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector.

CONCLUSION

There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways.

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.

Closeness and distance: a way of handling difficult situations in daily care

AIMS AND OBJECTIVES

The aim of this study was to describe how care team members caring for patients with advanced cancer describe how they handle difficult situations in daily care. In this paper 'difficult situations' refers to those situations team members themselves describe as difficult.

BACKGROUND

Serious illness and impending death involve great changes in a person's life. The care of patients with advanced cancer is complex and many different factors influence each care situation. This places demands on the way care team members handle problems and difficulties in daily care.

DESIGN

Qualitative descriptive study.

METHODS

The study is based on 16 focus group discussions with care team members who were caring for patients with advanced cancer at three different care units in two Swedish cities. The focus group discussions included 77 participants. The procedure for data analysis was inspired by the phenomenological method.

FINDINGS

The results show that care team members handled difficult situations by balancing between being close and distancing themselves. In most situations their choice of strategy seemed spontaneous rather than being a conscious decision, although it was sometimes described as a more conscious approach. Variations of closeness and distance that were identified were Identity, Meaning, Limit-setting and touching, Prioritization, the Team and the Organization. These could also be seen as tools that could facilitate or impede the use of closeness and distance.

CONCLUSIONS

The results show that care team members have a need to reflect over daily care and to become aware of what governs different care actions.

RELEVANCE TO CLINICAL PRACTICE

If the experienced difficult situation is not handled in a way that is beneficial to the care team member, patient and relatives, it is assumed that this can result in stress, burnout and, above all, non-optimal care.

Fungating wounds: informing practice through knowledge/theory

The assessment and management of fungating wounds is a challenging situation which necessitates nurses using many skills. Literature is limited, especially relating to the psychological issues that arise for the patient and his/her family. As nurses, we must begin to address this by considering how our philosophy, knowledge and theory impact on and inform our practice. This article will critique and explore the different influences that affect our way of being and thinking in the world and how we can guide practice by using our fundamental skills of caring.

Development of a group model of clinical supervision to meet the needs of a community mental health nursing team

Clinical supervision is an important tool in the development of quality nursing care. It involves a process of reflection upon practice, the aim of which is to improve clinical practices and hence improve patient outcomes. The term 'clinical supervision' is itself problematic in that it implies an hierarchical, rather than a nurse-centred and reflective, process. In addition there are a variety of models of supervision which range from the purely managerial to the clinical. This gives rise to confusion and in some cases suspicion, in clinicians. This paper reports on the development, implementation and evaluation of a group model of clinical supervision developed by a small team of mental health nurses in a community mental health setting. This team recognised the need for a formal clinical supervision model but was unsure as to the model which best suited their practice situation and needs. Through collaboration with a university department of nursing, this group developed its own model of group clinical supervision. This paper reports on the development of the model and its evaluation. The model was developed with a small team of community nurses and hence may not be applicable to other teams and other settings. However, the methods described may be useful as a guide to other nurses who wish to plan, implement and evaluate a model of clinical supervision in their workplace.

The dynamics and processes of 'ending' in clinical supervision

While there is a growing number of papers in academic and professional nursing journals that focus on clinical supervision, there remain unanswered questions and unresolved issues. One such issue where there is a distinct paucity of theoretical or empirical work is that of 'ending' within clinical supervision. Accordingly, this article examines key issues and dynamics of ending within clinical supervision. These key issues are summarized as: ending when the supervisor is reluctant to let go; parallel processes in ending in clinical supervision and ending in clinical relationships; the different ending dynamics of different approaches to clinical supervision; endings in group supervision; ending as a form of bereavement; healthy endings in clinical supervision; and endings as a opportunity for growth and celebration. The authors posit that an understanding of these processes can help facilitate a 'healthy' ending in clinical supervision. Furthermore, there may be particular merit in considering dynamics that, when present, create the best chance of all parties experiencing a health ending, namely: the ending is negotiated; the ending is gradual rather than sudden and all parties work towards the ending; the supervisee retains (wherever possible) a degree of control over the timing of the ending; and both supervisor and supervisee achieve a sense of closure.