Developing a manual for strengthening mental health nurses' clinical supervision

Online Group Supervision as Pedagogy: A Qualitative Inquiry of Student Mental Health Nurses' Discourses and Participation

This study explored online group clinical supervision participation, as a component of pre-registration education following mental health nursing students' clinical placements. Clinical supervision has historically been valued as a supportive strategy by healthcare professionals to develop practice and competence and prevent burnout. As many student nurses do not have access to clinical supervision via practice areas as a standardised process, their experiences of engaging in or benefitting from clinical supervision are wide-ranging. In view of this, we are identifying a theory-practice gap between theoretical knowledge and practice experience. This study incorporated a qualitative inquiry using reflexive thematic analysis and applying poststructural theoretical perspectives. Online group clinical supervision was delivered to student mental health nurses whereby focus groups followed to discuss their views, understandings and experiences of online group clinical supervision. This was against a back drop of Covid-19 lockdown restrictions. Thematic synthesis identified two main areas for improving participation and pedagogy comprising; Improving Confidence and Trust in (Online) Participation and The Need for Familiarity in CS Participation and Understanding. Thematic and poststructural analysis demonstrated participants' positive outlooks on the values of clinical supervision, whilst also identifying the finer nuances of the differences in accessing group clinical supervision through an online format. This study adds to the literature on using group clinical supervision within the student mental health nurse population by identifying the benefits of group clinical supervision for student nurses. It has additionally found that the silences and inhibitions surrounding online participation are important areas for further research.

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.

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.

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.

Fortalecer la coordinación de enfermería para mejorar el cuidado hospitalario

Introducción: La coordinación adecuada para organizar la atención de enfermería a nivel hospitalario es decisiva frente al servicio que se ofrece a los sujetos de cuidado y al mejoramiento permanente de la institución. Objetivo: Describir qué dice la literatura mundial sobre cómo fortalecer el rol de coordinación de enfermería a nivel hospitalario. Materiales y Métodos: Búsqueda integradora de literatura bajo parámetros de Ganong, con publicaciones arbitradas, observación de seis años, sin límites geográficos, en idiomas inglés, español y portugués.  Resultados: De acuerdo con la literatura surgen tres categorías que incluyen: características del rol de coordinador de enfermería; impacto de esta coordinación en los resultados frente al sujeto de cuidado; y estrategias para fortalecer el rol de coordinación dentro de la institución. La evidencia que respalda el desarrollo de la coordinación de enfermería en el hospital es débil, con una mayoría de estudios de tipo descriptivo. Discusión: La coordinación de enfermería debe articular la dirección y la operación en el hospital y para ello requiere conocer y acompañar la directriz institucional a mediano y largo plazo y manejar estrategias de motivación y acompañamiento para facilitar su logro. Conclusiones:  En una institución hospitalaria, la enfermera coordinadora debe mantener el norte en medio de la cotidianeidad de la asistencia; acompañar y motivar al personal a su cargo mediante competencias de liderazgo, trabajo en equipo y conocimiento clínico e institucional.  Requiere para el ejercicio de su rol, proyectar el cambio y mantener un pensamiento integrador. Como citar este artículo: Laverde Contreras Olga Lucia, Sánchez Herrera Beatriz. Fortalecer la coordinación de enfermería para mejorar el cuidado hospitalario. Revista Cuidarte. 2020; 11(2): e826. http://dx.doi.org/10.15649/cuidarte.826

Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study

BACKGROUND

Healthcare is delivered in a culture of ongoing change, with many nurses highlighting the impact of this on their own wellbeing. However, there is a dearth of literature focusing on how nurses care for themselves as they try to provide compassionate care in a challenging job.

OBJECTIVES

This study explored nurses' experience of self-care and self-compassion and how this may relate to compassionate care giving towards patients.

DESIGN

A constructivist grounded theory approach was used to develop a theoretical understanding of nurses' experience.

SETTINGS

This study included participants from two National Health Service (NHS) Trusts within the United Kingdom (UK).

PARTICIPANTS

Purposive and theoretical sampling were used to recruit general, mental health and learning disability nurses, at different levels of seniority.

METHOD

Between September 2015 and March 2016 semi-structured interviews were conducted. Analysis was completed in line with the process set out within constructivist grounded theory. Using constant comparison and memo writing, analysis moved from initial coding to focused coding, through to theoretical coding, resulting in the production of core concepts and categories, and theory development.

RESULTS

Thirty participants were included in the study. Three concepts were derived from the data: (1) 'Hardwired to be caregivers' - vocation versus role, (2) needing a stable base, (3) Managing the emotions of caring. All three concepts linked to a core process: needing permission to self-care and be self-compassionate. Nurses needed permission from others and from themselves to be self-caring and self-compassionate. An inability to do this affected their wellbeing and compassionate care giving to others. Interviewees described how they struggled particularly with self-compassion. Helping nurses to be proactively more self-caring and self-compassionate may increase their ability to manage emotions and prevent some of the negative consequences of nursing such as burnout and compassion fatigue. A conceptual framework is proposed which identifies that formal permission (e.g., within nursing guidance) may be necessary for some nurses to look after themselves.

CONCLUSION

Findings identified the need for permission as key in enabling nurses to self-care and be self-compassionate, which may facilitate them to address patients' needs. The study highlights the importance of self-care and self-compassion within nursing education and nursing guidance.

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.

Guiding CBT supervision: how well do manuals and guidelines fulfil their promise?

Written guidance is part of a coherent support system for CBT supervisors, consistent with general developments in evidence-based practice. In theory, training manuals can help by specifying educational procedures and providing support materials so as to foster fidelity, expertise and effectiveness among supervisors. Supervision guidelines can help by offering supervisors the fruits of research and expert consensus. Together with related resources, such written guidance promises to empower professionals and to benefit patients. But progress with written guidance is very limited within clinical supervision, particularly in controlled research. In marked contrast, locally developed guidance appears to have been implemented successfully within pragmatic studies, a marked achievement when also contrasted with the general healthcare literature. Using eight criteria, the available supervision research is reviewed and conclusions drawn on developing written guidance so as to better fulfil its promise.

How can video recordings best contribute to clinical supervisor training?

Significant progress has been made internationally in the training of clinical supervisors, yet much remains to be done, such as refining training through the improved use of video material. A review of currently available video recordings used in supervisor training indicates that they are generally used informally, are manifestly lacking in procedural detail, are narrowly applied, and lack an educational rationale or research support. After reviewing current options, a more precise, comprehensive and educationally informed framework is proposed, broadening the video options to 10 complementary applications. Systematic links are made between these applications, the core supervision competencies, and the related workshop content (especially training objectives and learning outcomes), culminating in an educational rationale for the use of video within a supervisor training curriculum. It is concluded that application of this framework can enhance the effectiveness and efficiency of supervisor training, helping to maintain progress.