Auditing a clinical supervision training programme

'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.

An investigation into the perceptions of clinical supervision experienced by learning disability nurses

This study explored perceptions of clinical supervision among community-based residential learning disability nurses in south-east England. A questionnaire generated a sample of 35, of whom 26 engaged regularly in clinical supervision. Respondents reported that supervision provided protected time to reflect on their skills and on their professional and personal development. They identified a need for greater clarity in the roles of supervisor and supervisee, and a clearer separation of managerial and developmental imperatives. They wanted support and preparation for supervision, and range of options for type of supervision and choice of supervisor. Thus supervision was found to be important for staff working in isolated community-based services for people with learning difficulties. However, little research has been carried out in this area. This study could help to shape and unify the future provision of clinical supervision.

Clinical supervision in the alcohol and other drugs field: an imperative or an option?

There is a growing interest in Clinical Supervision (CS) as a central workforce development (WFD) strategy. This paper provides a definition of and rationale for CS, characterises its various forms, identifies selection and training issues, and advises on policy and implementation issues central to redressing shortcomings in supervision practice within the alcohol and other drugs (AOD) field. Relevant selective literature is reviewed. Key conceptual issues were identified, and strategies developed to address implementation barriers and facilitate relevant policy. There is a common conceptual confusion between administrative supervision and CS. Clarification of the role, function and implementation of CS is required. Priority issues for the AOD field include: enhancing belief in CS; ensuring adequate resource allocation; developing evaluation protocols; and addressing specific arrangements under which supervision should occur. CS has been underutilised to date but holds considerable potential as a WFD strategy. It is fundamental to workers' professional development, can contribute to worker satisfaction and retention, and may improve client outcomes. Critical next steps are to establish the generalisability to the AOD field of the benefits observed from CS in other disciplines, and evaluate longer-term gains of CS programs.

Occupational stress and job satisfaction in mental health nursing: focused interventions through evidence-based assessment

In the UK, over 20 contemporaneous reports have shown that between one-quarter and one-half of National Health Service (NHS) staff report significant personal distress (Weinberg & Creed 2000). There exists a substantial body of evidence to suggest that high levels of stress are endemic throughout the NHS (Anderson et al. 1996), and that many of these stressors may be unique to health care (Payne & Firth-Cozens 1987, Calboun & Calboun 1993). Historically, responsibility for stress management has often been placed at the feet of the employee (Sutherland & Cooper, 2000). This individual orientation has lead to the development of practices designed to treat those exhibiting symptoms of stress, and a relative paucity of interventions oriented to the prevention and the management of workplace stressors. It can also serve to deter scrutiny of injurious workplace conditions, practices and procedures. This small-scale study examines stress and job satisfaction in community mental health nurses in a semirural area of North Wales. Based on self-report questionnaire feedback, focused interventions are described to enhance work satisfaction and help ameliorate occupational stressors. Interventions are described at the level of the individual, the team and the organization as a whole.

Clinical supervision as an emancipatory process: avoiding inappropriate intent

As clinical supervision becomes more widely implemented in the United Kingdom with concerns and resistances being eroded as practitioners discover its benefits, it is important that potential limitations and perhaps failures are avoided. This paper utilizes Johns' (1996) intent-emphasis axis to explore how a technical interest, misunderstanding of expert practice, and confusion of self awareness with counselling, can detract from the supervisory process. Several of the criticisms of reflective practice will be examined to demonstrate where concerns are valid and where they may be based on misunderstandings and the need to control clinical supervision. Greater awareness of inappropriate emphasis and intent should enable even relatively inexperienced supervisors to help their supervisees move towards independence, emancipation and evolving expertise.

Clinical supervision and managerial supervision: some historical and conceptual considerations

The current lack of consensus among authors in the United Kingdom on the concept of clinical supervision continues unabated, although enthusiasm for its implementation is being questioned by those who would be supervised. The literature now reports confusion among practitioners on the differences between clinical and managerial supervision, and supervision and therapy. This paper addresses the differences between clinical and managerial supervision by revealing nursing's history of clinical supervision. It is argued that until the current underlying conceptual ambiguities are identified and corrected, clinical supervision remains at risk of deteriorating into managerial supervision.

Lost in the crucible of supportive clinical supervision: supervision is not therapy

Clinical supervision as a mechanism that supports both professional and personal development is a concept that has captured the imagination of nurses. Though nurses generally agree that 'supervision is not therapy', a clear distinction cannot be enunciated between these two processes when both aim at personal growth. In combining personal and professional growth, the rationale for clinical supervision is unnecessarily confused, with the unfortunate result that supervision may, unwittingly, become a form of therapy for nurses. This paper examines a model of supportive clinical supervision qua Chambers and Long's example of a facilitative therapeutic supervisory style, that reflects nurses' conceptualization of clinical supervision as enhancing personal and professional growth. However, it could be argued that this stance is in crucial respects incorrect, and needs to be rethought if clinical supervision is to be established as credible in nursing. Subsequently, it is important to remember that the utilization of certain techniques rather than their stated goals, will dictate the form that supervision, or therapy, will take. The purpose of this paper is to demonstrate the logical unacceptability in combining two processes as one, while developing a conceptual framework that differentiates supervision from therapy.