ArticleLiterature Review

Clinical Supervision for Allied Health Professionals: A Systematic Review

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Abstract

It is recommended that allied health professionals (AHPs) participate in regular clinical supervision (CS). However, AHP understanding of CS processes and outcomes is unclear. This systematic review reports the evidence for CS for AHPs and other health professionals. Five databases and reference lists of included articles were searched. Papers included described CS definitions, processes and outcomes of CS. Due to the paucity of CS research for AHPs, nursing and medical disciplines were included. Two reviewers critically appraised the 33 included papers. The majority of papers were exploratory. Definitions and processes for CS were not clearly identified. Outcomes of CS included the relationships between CS and job satisfaction and workplace stress. Proctor's model and the Manchester Clinical Supervision Scale were the most common framework and evaluation approach. Contradictory positions of which components of Proctor's model should be included in CS were reported. Methodological flaws and a lack of comparative studies were common. Although not extensively supported by evidence, CS was generally held to be a positive experience and tends to be provided without a clear definition or model, using new or untested tools. Further research to evaluate CS for AHPs, is needed.

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... . Across the majority of allied health professions, clinical supervision is practised to enhance the professional development of clinicians and high quality patient care [8]. ...
... Clinical supervision has been defined as "the formal provision, by approved supervisors, of a relationshipbased education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s" ( [9] p. 440). Clinical supervision supports effective clinical governance and the professional wellbeing of allied health clinicians [8]. In conjunction with other forms of professional support, clinical supervision improves allied health recruitment and retention, particularly in non-metropolitan settings [10,11]. ...
... However, internationally, few allied health professions and jurisdictions have developed clinical supervision frameworks and most have been reported to be of low quality [23]. Additionally, there is limited longitudinal research measuring the impact of implemented clinical supervision frameworks [8]. ...
Article
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Background Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians’ perceptions of the implementation of an organisational clinical supervision framework. Methods A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA. Results There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation’s clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision. Conclusions Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.
... [3][4][5] Clinical supervision is widely practised amongst allied health professions as a mechanism for clinical governance and to support professional wellbeing. 6 Clinical supervision has been defined as "the formal provision, by approved supervisors, of a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s". 7 p. ...
... 440 It is proposed that clinical supervision contributes to the provision of safe, high quality healthcare by promoting evidence-based practice, improving clinical reasoning and creating opportunities for reflection and feedback. 6 Clinical supervision assists professional wellbeing by helping allied health professionals to manage the emotional demands of practice by providing a confidential space to discuss clinical issues and has been found to reduce professional isolation and burnout, particularly for rural allied health professionals. 6,8,9 Issues relating to the standards of clinical supervision for health professionals in the United Kingdom have been identified as a contributing factor to serious breaches of patient safety. ...
... 6 Clinical supervision assists professional wellbeing by helping allied health professionals to manage the emotional demands of practice by providing a confidential space to discuss clinical issues and has been found to reduce professional isolation and burnout, particularly for rural allied health professionals. 6,8,9 Issues relating to the standards of clinical supervision for health professionals in the United Kingdom have been identified as a contributing factor to serious breaches of patient safety. 10 In Australia, health system failures in recent years have highlighted the need for health services to ensure that there are appropriate systems and processes in place for effective clinical governance to ensure the delivery of safe and quality clinical care. ...
Article
Purpose: Clinical supervision is an important element of professional support for allied health professionals and contributes to the provision of safe, high quality patient care and health professional wellbeing. Structured clinical supervision frameworks have been recommended to improve access and effectiveness of clinical supervision for allied health professionals by providing practical guidance and increased consistency. However, there is limited evidence relating to the availability and quality of clinical supervision frameworks for allied health. Method: A systematic and critical review was conducted to identify and appraise clinical supervision frameworks for allied health. Included were peer-reviewed studies and grey literature documents, available in full text and written in English. Six databases and government and professional association websites were searched. The AGREE Health Systems Guidance (AGREE-HS) tool was used to appraise framework quality. Three researchers independently reviewed the frameworks and reached consensus on scores through discussion. AGREE-HS scores were analysed descriptively. Results: Twenty-six frameworks were appraised by the AGREE-HS including 7 peer-reviewed studies and 19 grey literature documents. Over half of all frameworks were from Australia, and the profession/s that they related to were most commonly allied health, social work, or psychology. The combined mean of the AGREE-HS final items scores for all studies/documents was 14.5 (SD = 4.0) out of a possible score of 35. Frameworks published in peer-reviewed studies used more robust methods to inform their development than frameworks sourced from the grey literature. In contrast, grey literature frameworks were often more clearly outlined, succinct, practical, and flexible for stakeholders to implement. Conclusions: There are limited published frameworks available for allied health professionals, and the frameworks that do exist are generally of low quality. As a result, many existing frameworks may not provide the practical guidance required to improve clinical supervision practice and optimise the benefits of clinical supervision. It is recommended that future policy relating clinical supervision needs to focus on the development of common, evidence-based allied health clinical supervision frameworks. Future frameworks should be practically orientated and use robust methods and evaluation to inform their development and implementation.
... This work builds upon prior reviews of the supervision literature (Alfonsson et al., 2018;Dawson et al., 2013;Hoge et al., 2011;Milne & James, 2000;Spence et al., 2001;Watkins, 2020;Wheeler & Richards, 2007). Strengths of these reviews included providing a comprehensive overview of the scope, format, and structure of supervision; summarizing strengths and limitations of the supervision literature; and reviewing evidence regarding the overall effectiveness of supervision. ...
... Second, which supervision practices (e.g., role play, modeling, etc.) are most frequently associated with formative and restorative outcomes? Given concerns noted in prior reviews regarding the quality of supervision research (Dawson et al., 2013;Wheeler & Richards, 2007), we also examined the methodological rigor of studies included in the current review. ...
... Of the abstracts screened, 118 articles were identified as relevant. In addition, the reference lists of other supervision reviews were examined (Dawson et al., 2013;Hoge et al., 2011;Milne & James, 2000;Spence et al., 2001;Wheeler & Richards, 2007). This method yielded one additional potentially relevant article. ...
Article
In this review, the authors examined supervision characteristics and practices associated with formative (e.g., skill development) and restorative (e.g., well-being) provider outcomes. We used qualitative review to summarize supervision characteristics associated with desired outcomes. Then, we applied a distillation approach to identify practices associated with formative and restorative outcomes. The most common practices for promoting formative outcomes were corrective feedback, discussing intervention, and role play. Findings indicate several supervision strategies have demonstrated empirical support for improving formative outcomes. However, more rigorous research is needed in community settings, particularly for understanding which strategies improve restorative outcomes.
... Whilst this is common practice [15], there is a lack of research on what happens at the frontline [12,14]. This is especially true for allied health professionals as most CS literature to date has focused on nurses and mental health professions [16,17]. As rural and remote practice comes with unique challenges [14], such as generalist roles with a broad scope of practice, it warrants further investigation. ...
... Most existing studies have used surveys to investigate CS practices [5,11,12,16,18,19]. Whilst survey studies are useful in building the evidence base, it is equally important to understand individual clinician perspectives to explain and contextualize survey findings. ...
... Although participants invited were from physiotherapy, occupational therapy, speech pathology, psychology, podiatry, dietetics, exercise physiology and social work, the interviewees recruited were from six of these professions (see Table 1). These disciplines were chosen due to similarities in CS practices between them, as well as in line with other similar studies in this field [16,18]. ...
Article
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Background The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants’ lived experiences with clinical supervision at the frontline. Methods Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews. Results Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision. Conclusions This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention.
... There is variation in the practice of clinical supervision between and within professions, as professional associations have varying guidelines for the practice of clinical supervision and the content of clinical supervision is often dictated by the needs of the supervisee [5]. However, there is some agreement among the allied health professions that it should fulfil the three domains of Proctor's model [6]. The restorative domain refers to supporting the professional through the emotional burden of practice, the formative domain refers to the development of clinical skills and the normative domain refers to compliance with organisational policies and procedures [7]. ...
... The restorative domain refers to supporting the professional through the emotional burden of practice, the formative domain refers to the development of clinical skills and the normative domain refers to compliance with organisational policies and procedures [7]. Established in 1986, the model has been implemented in the mental health, nursing, and allied health professions [6]. The model provides a framework for the broad functions of clinical supervision but does not stipulate the type of supervisor interventions that can be used to support the supervisee in each of these domains [8]. ...
... The MCSS-26 was used to measure the effectiveness of clinical supervision and has been validated for use by allied health professionals [12]. The survey is a self-completion tool and is the most commonly used tool to evaluate the effectiveness of clinical supervision [6,12]. The survey consists of 26 items, and it provides sub-scores for six key elements of clinical supervision including: importance/value of clinical supervision (5 items), finding time (4 items), trust/rapport (5 items), support/advice (5 items), improved care/skills (4 items), and reflection (3 items). ...
Article
Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective clinical supervision of allied health professionals improves patients’ outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence. Methods: A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure. Results: Physiotherapists (n = 27) and occupational therapists (n = 26) in inpatient rehabilitation were recruited and the medical records of their patients (n = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence. Conclusions: Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients’ mobility or personal care, respectively. • Implications for rehabilitation • Effective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients. • Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision. • Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice. • Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.
... 6 However, recent studies have demonstrated a lack of understanding and agreement of what CS is and how best to engage with it. [16][17][18] Although the benefits of CS to the health workforce remain undisputed, it is widely acknowledged in the literature that current supervisory practice in the health professions has very little empirical or theoretical basis. 18,19 CS is said to be the least investigated, discussed and developed aspect of clinical education. ...
... These professions were chosen because of the similarities in CS practices between them, as well as in line with other similar studies in this field. 16,17 Procedure The Manchester Clinical Supervision Scale (MCSS-26, available at http://www.osmanconsulting.com/info_mcss/ home_mcss.php.html, ...
... 26 Time has been consistently cited as a barrier to high-quality CS in several previous studies. 10,16,17,26,37 Martin et al. 26 have outlined several practical strategies to assist clinicians with competing priorities to prioritise CS time. This is an important consideration because previous research has indicated that when time is prioritised for CS, it can act as an enabler to achieve positive outcomes. ...
Article
Objective The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results Supervisee’s work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision.
... 5 Different cultures within AH professions impact the delivery of CS, with varying expectations for access to CS, its processes, and the availability of training and resources to support its implementation. 1,2 Various theoretical models have been developed to support CS. Proctor's Interactive Framework of Clinical Supervision has been increasingly cited in research, 1,6,7 following the development of a validated questionnaire, the Manchester Clinical Supervision Scale (MCSS), based on this model. 8 Proctor's model describes the functions of CS as being comprised of three domains: a) normative, comprising compliance with policies and procedures and professional issues such as ethics and confidentiality; b) formative, involving the development of clinical skills and embedding evidence-based practice; and c) restorative, whereby the supervisee is supported to manage the emotional demands of practice. ...
... 5 Different cultures within AH professions impact the delivery of CS, with varying expectations for access to CS, its processes, and the availability of training and resources to support its implementation. 1,2 Various theoretical models have been developed to support CS. Proctor's Interactive Framework of Clinical Supervision has been increasingly cited in research, 1,6,7 following the development of a validated questionnaire, the Manchester Clinical Supervision Scale (MCSS), based on this model. 8 Proctor's model describes the functions of CS as being comprised of three domains: a) normative, comprising compliance with policies and procedures and professional issues such as ethics and confidentiality; b) formative, involving the development of clinical skills and embedding evidence-based practice; and c) restorative, whereby the supervisee is supported to manage the emotional demands of practice. ...
... 8 Proctor's model describes the functions of CS as being comprised of three domains: a) normative, comprising compliance with policies and procedures and professional issues such as ethics and confidentiality; b) formative, involving the development of clinical skills and embedding evidence-based practice; and c) restorative, whereby the supervisee is supported to manage the emotional demands of practice. 1,8 In 2011, the MCSS was modified and validated in an AH context and renamed the MCSS-26. 9 Some Australian studies have recently used the MCSS-26 to measure the effectiveness of CS for AH professionals. ...
Article
Full-text available
Objective: Clinical supervision (CS) is widely used by allied health (AH) professionals, although with limited supporting research evidence. The aim of this study was to evaluate the effectiveness of CS for AH professionals in a regional health setting and to investigate differences in CS perceptions between AH disciplines. Methods: Within a participatory action research project, a quantitative cross-sectional survey was distributed to AH professionals at a regional Australian health service. Data were collected using the Manchester Clinical Supervision Scale (MCSS-26), and differences between disciplines were analysed with independent-samples t-tests and one-way between-groups ANOVA. Of a possible 258 participants, 106 responded to the survey (response rate 41%). The action research group assisted with the interpretation of findings. Results: The total mean for MCSS-26 scores across AH was 78.5 ± 13.9 (SD), which is above the recommended threshold score for effective CS (73). There were statistically significant differences in total scores between occupational therapy (82.8 ± 14.4) and physiotherapy (70.9 ± 11.3) and in the formative and restorative domains. Conclusions: While CS was perceived to be effective, there were significant differences between some disciplines. The findings demonstrate that CS is effective when it is practised within a structured framework; however, flexible models of CS across disciplines need to be explored.
... Proctor's model (Proctor, 2000) was used to inform the development of interview questions and interpret results. This model includes restorative, formative, and normative approaches and is recognised for guiding clinical supervision practices and analysis (Dawson et al., 2013). This research project was approved by the Flinders University Human Research Ethics Committee (ID: 5238). ...
... Participants provided several recommendations to improve clinical supervision for NDIS-PBS practitioners, including the need for supervisors to received specific training and the importance of supervisors having both PBS expertise and good understanding of registration requirements and practice obligations. The findings of this research also emphasised the importance of all three functions of Proctor's model of clinical supervision (Dawson et al., 2013). The "restorative" function was highlighted with emphasis on a supportive and trusted supervisory relationship, which helped to address stress levels and practitioner burnout, in addition to more technical practice guidance. ...
... En la estadía profesional de los programas de educación veterinaria, este modelo es una garantía para el verdadero aprendizaje, los supervisores observan y evalúan el desempeño en el lugar de trabajo. Los supervisores siempre están atentos a los puntos críticos de los procesos para hacerlos conjuntamente con el estudiante hasta que este logre un nivel de perfeccionamiento y se le encomiende hacer lo mismo, pero ya de manera independiente, con poca o nula supervisión, por lo que el ambiente interno en el lugar de trabajo se va confeccionando hasta que se lograr una integración total entre el estudiante, el supervisor, los demás compañeros y las actividades realizadas profesionalmente sobre la casuística que brinda el contexto de la estadía (Kennedy, Regehr, Baker, Lingard, 2005), (Dawson, Phillips, Leggat, 2013). ...
... Por lo tanto, queda pendiente un mayor trabajo de colaboración entre la institución que otorga los grados y los centros de colaboración contextual, para retroalimentar de manera más puntual sobre la preparación profesional de los estudiantes en la recta final del programa formal de licenciatura en la medicina veterinaria y la producción animal. Se ha reconocido que el supervisor profesional experto tiene muy claros los procesos clínicos y de producción animal, además de identificar los momentos de su intervención para observar, participar y evaluar, y de esa manera, hacer ver a los estudiantes el momento en que pueden realizar tareas sin supervisión directa, a tal grado que también les confieren la toma de decisiones en sus procedimientos (Sebok-Syer et al., 2018), (Dawson et al., 2013). ...
Article
Full-text available
La evaluación de la estadía profesionalizante en el lugar de trabajo es de gran importancia para una retroalimentación institucional y la satisfacción de las expectativas de aprendizaje de los estudiantes, son dos objetivos principales que deben estar presentes en cualquier innovación en la educación superior, pues se va construyendo y perfeccionando una herramienta de evaluación curricular. La educación veterinaria ha estado marcando recientemente tendencias hacia un modelo de aprendizaje en escenarios reales bajo la supervisión de un experto profesional, sin embargo, dado que dichos expertos no tienen relación laboral con las instituciones que otorgan los grado, tampoco están obligados a participar en alguna reestructuración curricular, solamente firman el informe de desempeño que entregan mensualmente los estudiantes a los que supervisaron la práctica profesional durante uno o dos semestres en el área clínica o de producción animal, dos de las áreas principales del ejercicio profesional del médico veterinario zootecnista. Este estudio recopiló datos cuantitativos y cualitativos de una cohorte de estudiantes (130) que culminaron su programa de estadía profesionalizante. Se evaluaron aspectos relacionados con la organización de la estadía y la opinión que les merece el desempeño de los supervisores externos e internos. Se muestra las preferencias de los estudiantes sobre la especie animal y las áreas del conocimiento de interés, también la expresión sobre la participación de los supervisores en su formación profesional y la organización del programa de estadías. En las gráficas se muestran resultados con la puntuación respectiva a los indicadores evaluados.
... Clinical supervision for allied health professionals can be enhanced through organisational strategies, facilitating safe and high-quality patient care. 1,2 Clinical supervision has been defined by Milne as "the formal provision, by approved supervisors, of a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s" 3 (p 440). In rural settings, clinical supervision is a valuable component of professional support, making a positive contribution to the recruitment and retention of the allied health workforce. ...
... 18 Despite increasing evidence relating to factors enhancing the quality of clinical supervision, most research has captured the perspectives of supervisees rather than clinical supervisors or managers. 1,2,4 Additionally, there is limited longitudinal research evaluating the implementation of allied health clinical supervision. While a comprehensive model for clinical supervision implementation for nurses has been developed, 19 similar evidenced-based and comprehensive models are not available for allied health. ...
Article
Full-text available
Objective: To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting. Setting: A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services. Participants: Allied health managers employed at the health service were members of an action research group. Design: This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis. Results: The action research group met 11 times over a 5-year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision. Conclusion: The findings from this comprehensive longitudinal study provide evidence-based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health.
... 14,15 Formative will usually revolve around the educational elements of professional supervision with discussion around clinical processes and evidence-based practice. 14,16 Finally, the Restorative function is based on the support of the supervisee. In the Restorative function, discussion around emotional situations and strain, checking for burnout and general discussion around the supervisee's mental wellbeing enable interventions and direction for help as needed. ...
... 18,23e25 This is an important finding given that the elements of emotional support, trust, rapport and supervisor advice and support sit within the restorative domain of professional supervision. 16 It should also be acknowledged that the restorative domain can play a key function in enabling professionals feel supported and to check for aspects of burnout. 19 When discussing burnout, it is crucial that this is recognised at an early stage to allow support mechanisms to be activated and to empower the professional to seek appropriate help and support where required. ...
Article
Full-text available
Objectives The sonographer workforce in the UK is under pressure due to chronic staff shortages and increased service demands. The Health and Care Professions Council and the Society of Radiographers both advocate for the use of professional supervision to support wellbeing and development, however the use of professional supervision is not widespread within the sonographer workforce. The aim of this literature review was to explore the evidence around the use of professional supervision and how this could support sonographer wellbeing. Key findings Professional supervision was found to be of importance for providing emotional support which can lead to increased job satisfaction, lower levels of burnout and subsequently impact on retention of the workforce. Professional supervision supported personal development and therefore increased quality of patient care, allowing professionals to discuss evidence-based care, policies and practice development through reflection. Whilst important for emotional and professional support, this review found that there are conflicting pressures which can impact the effectiveness of supervision including the supervisory relationship itself and time and organisational pressures. Demands on the workforce made a significant impact on the availability of quality clinical supervision. Conclusion Professional supervision has an important role in supporting the sonography workforce and enable increased wellbeing and emotional support. There are clear benefits to undertaking professional supervision to support the workforce however there are competing demands which may affect the effectiveness of professional supervision. Implications for practice There is limited international research on the use of professional supervision in the radiographer and sonographer workforce. There are clear benefits for supporting professional wellbeing and development under a structured professional supervision framework however within the United Kingdom there is a significant gap in the literature where further research is required.
... Clinical supervision has been de ned as "the formal provision, by approved supervisors, of a relationshipbased education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s" (8 p. 440 ). Clinical supervision supports effective clinical governance and the professional wellbeing of allied health clinicians (7). In conjunction with other forms of professional support, clinical supervision positively impacts on allied health workforce recruitment and retention, particularly in non-metropolitan settings (9,10). ...
... However, internationally, few allied health professions and jurisdictions have developed clinical supervision frameworks and most have been reported to be of low quality (22). Additionally, there is limited longitudinal research measuring the impact of implemented clinical supervision frameworks (7). ...
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Background: Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians’ perceptions of the implementation of an organisational clinical supervision framework. Methods: A cross-sectional study was conducted as a phase of an overarching participatory action research study. The MCSS-26 tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA. Results: There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation’s clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision. Conclusions: Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have positively impacted on the effectiveness of clinical supervision for some professions.
... Clinical supervision is widely used for allied health professionals to enhance clinician confidence, learning and support and improve organisational clinical governance. 1 In rural and regional settings, clinical supervision for allied health professionals has been proposed to decrease professional isolation, improve work satisfaction and reduce the risk of burnout. 2,3 Clinical supervision may positively impact the recruitment and retention of the rural allied health workforce. ...
... 29 A limiting factor for recommending group clinical supervision is the relatively few published studies of group clinical supervision for allied health. 1,2 The majority of existing studies of group clinical supervision for health professionals are from nursing or mental health professions, and most studies have not used validated evaluation tools, making it difficult to generalise findings to other professions. 13,19,25 A large pilot study of peer group supervision was conducted for Queensland allied health professionals working in rural and metropolitan settings. ...
Article
Objective: To evaluate a group clinical supervision program for allied health professionals in a regional health service. Design: This study used a mixed-methods design including a cross-sectional, quantitative survey of group clinical supervision participants and a focus group of facilitators. Setting: A large regional health service in Victoria, providing hospital, community and mental health services. Participants: Allied health professionals and managers employed at the health service. Interventions: Group clinical supervision, based on a critical reflection model, was implemented in 3 settings. Main outcome measure: The Clinical Supervision Evaluation Questionnaire was administered to group clinical supervision participants, with additional open-ended questions included. The Clinical Supervision Evaluation Questionnaire tool consists of 3 subscales relating to the purpose, process and impact of group clinical supervision. A focus group was used to capture the perspectives of group clinical supervision facilitators. Results: Fifteen survey responses were received. The overall Clinical Supervision Evaluation Questionnaire score was 56.53 (standard deviation 7.66). Scores for the Process Subscale were higher than the Purpose and Impact subscales. Themes from the open-ended survey questions included the following: value of multiple perspectives, opportunities for reflection, peer support and group process and structure. Themes from group facilitators' focus group included the following: need for group clinical supervision, value of facilitator training and support, and sustainability. Conclusion: Group clinical supervision was perceived to be effective, enhancing reflection, learning and peer support. Organisational support, facilitator training, group structure and planning for sustainability were identified as critical factors for success. Interprofessional and cross-organisational models of group clinical supervision are strategies that could help address issues relating to access to quality clinical supervision for rural allied health professionals.
... The allied health professions have adopted Proctor's model of clinical supervision to guide them in their clinical supervision practice [7]. Proctor's model of clinical supervision describes how health professionals can be supported in the formative, restorative and normative domains of practice [8]. ...
... The MCSS-26 results showed that finding time was a barrier to effective clinical supervision and is consistent with previous findings [7,11,12,[14][15][16][17]. Allied health professionals who report difficulty finding time for clinical supervision also report higher levels of emotional exhaustion [47]. ...
Article
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Background: Clinical supervision is recommended for allied health professionals for the purpose of supporting them in their professional role, continued professional development and ensuring patient safety and high quality care. The aim of this mixed methods study was to explore allied health professionals' perceptions about the aspects of clinical supervision that can facilitate effective clinical supervision. Methods: Individual semi-structured interviews were conducted on a purposive sample of 38 allied health professionals working in a metropolitan public hospital. Qualitative analysis was completed using an interpretive description approach. To enable triangulation of qualitative data, a quantitative descriptive survey of clinical supervision effectiveness was also conducted using the Manchester Clinical Supervision Scale (MCSS-26). Results: Three main themes emerged from qualitative analysis: Allied health professionals reported that clinical supervision was most effective when their professional development was the focus of clinical supervision; the supervisor possessed the skills and attributes required to facilitate a constructive supervisory relationship; and the organisation provided an environment that facilitated this relationship together with their own professional development. Three subthemes also emerged within each of the main themes: the importance of the supervisory relationship; prioritisation of clinical supervision relative to other professional duties; and flexibility of supervision models, processes and approaches to clinical supervision. The mean MCSS-26 score was 79.2 (95%CI 73.7 to 84.3) with scores ranging from 44 to 100. MCSS-26 results converged with the qualitative findings with participants reporting an overall positive experience with clinical supervision. Conclusions: The factors identified by allied health professionals that influenced the effectiveness of their clinical supervision were mostly consistent among the professions. However, allied health professionals reported using models of clinical supervision that best suited their profession's role and learning style. This highlighted the need for flexible approaches to allied health clinical supervision that should be reflected in clinical supervision policies and guidelines. Many of the identified factors that influence the effectiveness of clinical supervision of allied health professionals can be influenced by health organisations.
... Clinical supervision of physiotherapists is recommended in national healthcare standards to ensure they are supported to provide high-quality care. 1 Clinical supervision typically involves an experienced clinician guiding a less experienced clinician through opportunities to enhance skill development and provide support to fulfil their professional role. 2,3 Effective clinical supervision of physiotherapists can enhance quality of care and physiotherapists' professional well-being. 4,5 Despite the benefits of clinical supervision up to 29% of physiotherapists do not receive any supervision. ...
Article
Objective This study aimed to explore physiotherapist and manager perceptions of factors that influence physiotherapist participation in clinical supervision. Methods Individual semi-structured interviews were conducted with physiotherapists (n = 15) and managers (n = 10) from a publicly funded health network. Interviews were audiotaped and transcribed verbatim. Qualitative analysis of transcripts was completed using inductive thematic analysis. Results Three themes explained the factors perceived by participants to influence participation in clinical supervision: the value of clinical supervision; operationalisation of the organisational clinical supervision framework; and the clinical supervision culture. Identified factors influenced participation by either facilitating or discouraging access to supervision and prioritisation of supervision relative to competing professional demands. Conclusions Physiotherapist participation in clinical supervision is crucial for their professional development and to deliver high-quality care. Participation might be enhanced by initiatives that address factors identified in this study. These may include introducing processes that ensure supervisees and supervisors are accountable for their participation in supervision; providing alternative supervisory arrangements during leave, vacancies, or redeployment; allocating on-site supervisors to accommodate preferred supervision formats; and promoting a safe learning environment where physiotherapists can address knowledge or skill gaps without fear of judgement.
... The literature and research on supervision has mostly described effects on acquisition of skills and knowledge among students and trainees (Chircop Coleiro et al., 2023;McMahon et al., 2022); how this activity may serve as a quality control for the patient and public or facilitate professional development (Grant & Schofield, 2007), promote resilience (Proctor, 1987), or prevent burnout among the supervisees (Dawson et al., 2013;Wallbank, 2013). However, novel clinical practice models should also examine the potential positive and/or negative effects on the supervisors. ...
Article
Learning by co-working with experienced therapists is rare in clinical psychologists' education; high working demands in clinical services challenge the provision of such situated learning. This study examined the feasibility of providing an apprenticeship model within ordinary mental health care clinics. The perspectives of nine clinicians participating as supervisors were explored through focus-group interviews. Reflexive thematic analysis yielded three themes organized on a continuum from an intra- to interpersonal perspective on teaching: meaningfulness in contributing tacit knowledge, experiences of joy and motivation when teaching, and the positive influence of students' naïve gaze in the therapeutic dyad for the therapeutic process.
... When considering the support mechanisms such as debriefing, Schwartz rounds, and peer support that are currently in place for sonographers, it appears they all have a potential to play a part in the restorative domain of professional supervision by providing the opportunity to discuss, debrief and support the emotional wellbeing of the professional. 9,19 This is a topic discussed by Driscoll and O'Sullivan 11 who propose that informal support mechanisms, such as peer support or break time discussion, do provide informal support for professionals. Likewise, research has shown that the opportunity to attend a Schwartz round, which creates the opportunity to discuss the emotional challenges of clinical practice, can be vital in creating a reflective space to process the feelings that may develop from challenging or distressing situations. ...
Article
Introduction: Professional Supervision has been described across multiple professional groups, however to date, minimal research has been conducted exploring the use of professional supervision within the United Kingdom (UK) sonographer workforce. Methods: An online self-administered survey was conducted to explore UK sonographers views on the use of professional supervision in practice. The survey was open to sonographers, consultant or clinical specialist sonographers, ultrasound managers and professional body officers. Multiple choice questions were utilised to obtain quantitative data on the provision of support mechanisms, with free text questions allowing qualitative data to be elicited further to explore thoughts of participants. Results: A total of 112 participants completed the survey in full and response rates varied across the subgroups. Varying support mechanisms were in place for sonographers. However only 55.4 % of sonographers felt supported in the clinical workplace. Thematic analysis of qualitative data highlighted that workload pressures, staffing and retention of sonographers, were key concerns that professional supervision could improve. It was highlighted that time to undertake professional supervision could be challenging, however if training for professional supervision was in place then this could provide improved quality of care and staff support. Conclusion: Participants highlighted the challenges faced by UK sonographers and the positive impact that professional supervision could have on retention and staff support. There are limited support mechanisms in place for UK sonographers and this is impacting on how participants felt they were being supported in the workplace. Stage 2 of this research project will explore sonographers' views in more detail. Implications for practice: The approach to support mechanisms for sonographers should be considered to support improvement of professional wellbeing and retention of the sonographic workforce.
... Overall, the ndings emphasise that 'one size does not t all' and suggest a need for tailored approaches designed [17][18][19] . Tailored approaches will therefore need to meet disciplinary and grade needs (and their intersectionality) while also responding to the local organisational context. ...
Preprint
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Objective: The aim of this study was to describe the effectiveness and quality of clinical supervision for Allied Health clinicians across nine disciplines, from the perspective of supervisees and supervisors. In a metropolitan public health service. Methods: Cross-sectional, quantitative descriptive design utilising online survey data collection via the MCSS-26 (previously known as the Manchester Clinical Supervision Scale). The survey was distributed online, and all responses were anonymous. Descriptive and comparative analyses were undertaken to interpret the data. Results: A total of 164 allied health and community services health clinicians responded, demonstrating a response rate of 36%. The majority of participants were female, in Grade 2 positions, and received clinical supervision monthly. Patient-related issues were discussed most frequently during these sessions. The delivery of most clinical supervision continues to utilise traditional one-to-one formats, although some professions (such as physiotherapy, occupational therapy, and nursing) experimented with alternative models. While total scores suggested the participants experienced effective supervision, there was significant variation across disciplines and grades. Moderate to strong correlations were also found between MCSS-26 subscale and total scores and overall satisfaction with clinical supervision. Conclusion: These findings emphasise the importance of tailored approaches to clinical supervision, considering the varied needs and perceptions of different individuals, professions and grade levels.
... The evidence for clinical supervision's impact on client outcomes is mixed, but it has been found that attendance at relationally focused supervision was significantly related to improved client outcomes (Bambling et al., 2006). Furthermore, having regular clinical supervision in the workplace has been related to reduced levels of staff sick leave, burnout and stress (Dawson et al., 2013;Wallbank, 2013). Thus, establishing regular clinical supervision in healthcare organisations can be valuable in supporting practitioner competency and resilience. ...
Article
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There is a growing body of literature highlighting the need for reflective supervision to support the often complex and challenging practice of social care workers. The current study aimed to explore an Irish social care team's experience of a pilot reflective supervision group. The study participants were six male social care workers supporting autistic adults in the community. The team met for four one-monthly group supervision sessions, facilitated by an external supervisor. A reflective, relational approach was taken to the supervisory work, using role-play, free association and the Seven-Eyed model of supervision. At the end of the four-month pilot, participants completed a brief questionnaire to evaluate the supervision group experience. Thematic analysis of the participants' open responses revealed the following themes: (i) increased insight/empathy; (ii) experiential learning; (iii) enhanced awareness/skills in relational practice; (iv) personal resilience; (v) team resilience; and (vi) emotional challenges. The study results suggest the potential importance of reflective supervision in boosting resilience, motivation and emotional insight when supporting people with unique relational needs.
... Importantly and finally in a recent systematic reviews and meta-analysis study of 95 studies, found a significance in supervision being a protective factor against depersonalization, low levels of accomplishment, low job satisfaction and a sense of being unfairly treated which after receiving professional supervision reversed the trend (O'Connor et al, 2018;Dawson et al, 2013). Notably, studies with primary focus on looking into factors that create burnout, suggested that health professionals are likely to feel 40% more emotional exhaustion when compared to the public. ...
Technical Report
EXECUTIVE SUMMARY Health New Zealand services in the Waitematā region provide high quality care to a growing population. To continue in its success in delivery of optimal healthcare the staff need continued support. This professional supervision project has established a Single Point of Entry into Supervision Network. This will aid staff in meeting the rising demands, reduce burnout, sickness and continue in the long tradition of providing high quality care to consumers (patients and whānau). To ensure professional supervision for all nurses and midwives, to promote candor, compassion, competency and flexibility within evidenced based practice, this form of professional development offers one investment approach to our nurses and midwives ongoing growth, retention and quality service delivery. It is acknowledged further work and Organisational commitment to professional supervision is needed to enable its sustainability.  Opportunity: Post pandemic, staff are feeling overwhelmed.  Mission: To provide professional supervision  Your Solution: Single Point of Entry into Supervision Network  Market Focus: For all Te Whatu Ora Waitematā nurses and midwives  Expected Returns: Support and care for nurses through ongoing professional development in the form of professional supervision; safe, quality and cost effective care of consumers (patients and whānau).
... The formative function links supervision to the development of professional knowledge and skills; the restorative function links it to practitioner wellbeing [22,23]; and the normative function links it to organisational procedures. The notion of three functions or purposes of clinical supervision is evident across diverse professions including social work [22], educational psychology [24], allied health [25], medicine [6] and nursing [26]. Although there are many models of clinical supervision, particularly in the nursing literature, most are narrative [27] and supervision practices in medicine have little empirical basis [4,[28][29][30] The medical education literature assumes that Proctor's model of clinical supervision also applies to educational supervision but this has not been tested empirically [7]. ...
Article
Full-text available
Background Educational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England. Proctor’s three-function model of clinical supervision (consisting of formative, restorative, and normative functions) is assumed to apply to educational supervision, but this has not been tested empirically. The aim of this study was to establish perceptions of the purpose of educational supervision from the perspective of primary care pharmacy professionals enrolled on a national training pathway in England. Methods Using a mixed methods design, data were collected using a validated 25-item online survey and respondents were invited to add comments explaining their responses. The survey was sent to all 902 learners enrolled on a postgraduate training pathway for pharmacy professionals working in primary care. Principal components analysis (PCA) was used to interpret patterns in the survey data, and framework analysis of qualitative free text comments was used to identify themes and aid interpretation of quantitative findings. Results One hundred eighty-seven pharmacy professionals responded (response rate 20.7%). PCA extracted three factors explaining 71.5% of the total variance. Factor 1 corresponded with survey items linked to the formative function of Proctor’s model, while factor 2 corresponded with survey items linked to the restorative function. No items corresponded with the normative function. Framework analysis of qualitative free-text comments identified two themes: learning support, which corresponded with factor 1; and personal support, which corresponded with factor 2. Conclusions This study identified that pharmacy professionals perceived educational supervision to perform two functions, formative (educational) and restorative (pastoral), but did not perceive it to perform a normative (surveillance) function. Educational supervision has the potential to support allied health professionals advancing their roles and we suggest the need for more research to develop models of effective educational supervision which can inform practice.
... It has been advocated that the nature and quality clinical supervision is a vital part of the development of clinical skills [8]. Internationally, it is common for healthcare professions to have structured support frameworks for support of practice-based learning [9,10] and in the UK there are developing supervision models for advanced pharmacy practice [11]. This need for consideration of structures and processes within the organisational environment has also been shown in other countries [12,13] and has relevance in primary and secondary care. ...
Article
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Background Scottish Government is increasing independent prescribers (IP) in community pharmacy (CP). A new preceptorship model using IPs as Designated Prescribing Practitioners (DPPs) has been introduced. Aim To investigate stakeholder views of implementation of a novel regulator mandated IP course preceptorship model. Method A theory-based online pre-piloted survey of stakeholders including e.g. directors of pharmacy, prescribing, education leads, policy & strategy leads and CPs. Questionnaire development used Consolidated Framework for Implementation Research (CFIR) and a DPP Competency Framework. Data were analysed descriptively and presented with mapping to CFIR constructs. Results Of ninety-nine responses 82.5% (80/97) responded ‘yes’ to ‘..abilities in reporting concerns..’ and 53.1% (51/96) indicating ‘no’ to ‘..anticipated issues with clinical and diagnostic skills’. CFIR related facilitators included agreement that; there was tension for change with 84 (85%) indicating ‘….urgent need to implement role …’, that incentives are likely to help (6566%) and small pilots would help (8588%). Barriers were evident related to ‘unsure’ responses about sufficiency of; DPP capacity (39/97, 40.2%), time (48/96, 50%) and support and resources (4445%) to undertake the role. Concerns were expressed with 81 (83%) in agreement or unsure that leadership commitment may be lacking and 48 (48.9%) were ‘unsure’ about availability of good training for the DPP role. Conclusion There was DPP role positivity but expressed barriers and facilitators at policy, organisational and individual practitioner levels needing further consideration. Further research is warranted on uptake and embedding of the role.
... 16 While both mentoring and clinical supervision include a focus on learning and professional support, the scope of clinical supervision usually includes restorative, administrative and evaluative functions. 17,18 The reported benefits of mentoring include being able to deliver positive clinical outcomes, 15 improve the communication skills of clinicians, 19 career advancement of mentees and mentors 13 and the ability to create change in a work setting. 14 Alongside the reported benefits, challenges associated with mentoring have been reported when there is poor quality of communication in the mentor/mentee relationship or due to ineffectual mentoring program structures. ...
Article
Objective: To describe how allied health professionals have used mentoring as a knowledge translation strategy to inform practice. Introduction: Mentoring has been reported to be used by nursing and medicine as a knowledge translation strategy. It is not known if allied health professionals have also used mentoring to improve their use of research in practice, or what the key mentoring characteristics are that guide its application in allied health settings. Improved understanding of the barriers and facilitators to mentoring in allied health settings may be used to guide the design of future mentoring programs to assist knowledge translation. Inclusion criteria: Eligible studies must have included allied health professionals, and used the concept of mentoring to support knowledge translation in the context of healthcare. Primary empirical and synthesized studies were eligible. Methods: An a-priori protocol was followed to complete a search of six databases (MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCO], PsycInfo [OVID], PDQ-Evidence (www.pdq-evidence.org), and Cochrane on the 9 March 2021. Screening for eligibility was conducted by two authors at the title and abstract stage and the full text stage. Selection criteria and the data extraction tool were established prior to the search. Findings are presented in narrative and tabular formats. Results: A total of 2053 studies met the inclusion criteria for screening and nine were determined to be eligible for inclusion. Mentoring has been used by allied health professionals to improve the translation of interventional research evidence by clinicians, and to establish clinician skills and knowledge relating to knowledge translation processes. Mentoring was predominantly used as part of a multifaceted knowledge translation strategy alongside educational strategies. Mentoring characteristics such as structure, context, goals, resourcing and dosage varied depending on the context of translation. The specific barriers reported to using mentoring were varied, whereas the facilitators to mentoring were primarily related to the mentor's approach and expertise. The impact of mentoring was primarily measured through the mentee's experience of mentoring. Conclusions: Allied health professionals have used mentoring as a knowledge translation strategy to enhance the use of research evidence in their practice and to learn the process of knowledge translation. Mentoring is mostly used in conjunction with other strategies in practice, such as education. The limited number of identified barriers and facilitators to using mentoring as a knowledge translation strategy supports the need for future research to deepen our understanding about the mentoring process.
... QuEDS consultation service receives more requests from dietitians seeking ED-specific support and training than can be supported with individual supervision. However, there is a dearth of studies available on the effectiveness of group clinical supervision for allied health [8]. ...
Article
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Background The recently published Australia and New Zealand Academy of Eating Disorders (ANZAED) practice and training standards for dietitians providing eating disorder treatment recommended dietitians working in eating disorders (EDs) seek further clinical experience, training, and supervision to provide effective evidence-informed treatment. Access to dietetic clinical supervision is problematic, secondary to limited trained supervisors, location, cost, and lack of organizational support. Demand for clinical supervision increased with the 2022 introduction of ANZAED credentialing for eating disorder (ED) clinicians in Australia and addition of the Eating Disorder Management Plan to the Medicare Benefits Scheme. In 2018, QuEDS piloted a model of online peer group supervision with the goal of increasing service capacity to provide ED-specific clinical supervision to dietitians. Positive evaluation of the pilot led to the rollout of QuEDS Facilitated Peer Supervision (QuEDS FPS) program which was evaluated for utility and acceptability. Methods By August 2021 five QuEDS FPS groups were established each with a maximum of 10 Queensland-based dietitians from public hospital, community, or private practice plus an additional Facilitator and Co-facilitator. A total of 76 participants enrolled in the program over the study period in addition to the 10 participants from the pilot program. Participant experience was evaluated with anonymous, voluntary surveys at baseline (59 responses), 6 months follow-up (37 responses), plus a one-off survey in August 2021 (50 responses). Pilot participant’s Baseline and Follow-up surveys were not included in this evaluation. Results Survey responses were positive across the four Kirkpatrick training evaluation domains of reaction, learning, behavior, and results. Respondents reported positive change to clinical practice (98%), including increased confidence to implement evidence-informed guidelines, and improved engagement with, and advocacy for, ED clients. Service capacity to provide supervision was increased by high participant to Facilitator ratios (10 participants to one Facilitator and one Co-facilitator) and recruitment of external Facilitators. Respondents indicated they would recommend QuEDS FPS to other dietitians and 96% planned to continue with the program. Conclusions QuEDS FPS program increases capacity to provide supervision with demonstrated positive impacts on dietitians’ confidence and ability to deliver dietetic interventions in the ED arena and, by inference, the dietetic care of people with an ED.
... Internationally, most healthcare professions such as medicine and nursing have formal support structures to facilitate workplace-based learning and safe practice [13][14][15][16] including mentors, preceptors and clinical supervisors [17]. Supervision has been defined as "the provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainee's experience of providing safe and appropriate patient care" [18]. ...
Article
Full-text available
Pharmacy professionals are increasingly moving into advanced roles, including in primary care. In England, the publicly funded Pharmacy Integration Fund (PhIF) enabled employment and training of pharmacy professionals in new patient-facing roles, including general practice and care homes. In recognition of the need for support and supervision during work-based learning and building on established support structures in medicine and nursing, one of the providers of PhIF funded learning developed a supervision structure which mirrors arrangements for postgraduate medical specialty training. This paper describes what informed this supervision model, with a particular focus on educational supervision, its delivery, and the training which was developed to support supervisors. This supervision enabled pharmacy professionals moving into primary care to practise safely, manage workplace challenges, extend their roles and make progress with their education. This model illustrates the benefits of supervision in supporting post-registration learning to facilitate the development of advanced patient-facing clinical roles.
... But yeah I think issues around sustainability, you could argue that, but hopefully it creates stability.'-Manager burnout among AOD workers [31]. Participants perceived the AOD workforce to experience high rates of stress and burnout due to heavy workloads and the incidence of vicarious trauma, consistent with previous findings [32][33][34]. ...
Article
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Introduction: Internationally, clinical/practice supervision is considered essential in the development and maintenance of professional proficiency across health disciplines. Among alcohol and other drug (AOD) workers, however, access to effective clinical supervision is limited. This study examined perceived barriers and facilitators to: (i) AOD workers accessing effective clinical supervision; and (ii) effective implementation of a clinical supervision exchange model in the AOD sector. Methods: Qualitative interviews with frontline workers (n = 10) and managers (n = 11) employed by eight government and non-government AOD treatment services in Brisbane, Australia were undertaken. Interviews were audio recorded, transcribed and data were thematically analysed. Results: Frontline workers and managers shared similar views. Reported barriers and facilitators to accessing effective clinical supervision included limited time, the high cost of providers, availability of skilled clinical supervisors, supervisor-supervisee matching and supervision modality. Participants considered the implementation of a clinical supervision exchange model to be a resource-effective strategy to increase access to external, individual clinical supervision while also exposing workers to a greater diversity of perspectives, increasing sector collaboration and improving the perceived value of clinical supervision among the workforce. Discussion and conclusions: The findings of this study suggest that limited time, cost and availability of skilled supervisors are primary barriers to AOD workers accessing high-quality clinical supervision. Implementation of a clinical supervision exchange model is perceived by frontline workers and service delivery managers to be a resource-effective strategy for increasing access to high-quality clinical supervision among workers.
... Investigating the impact of supervision on clients is methodologically challenging and has produced mixed results to date (e.g., Bambling et al., 2006;Whipple et al., 2020). However, attending supervision has been associated with improved competency (e.g., Alfonsson et al., 2020;Schwalbe et al., 2014), greater job retention and satisfaction, and reduced burnout and stress (Dawson et al., 2013;Wallbank, 2013). ...
Article
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In this observational study, recordings of 40 individual supervision meetings over six months for five supervisory dyads in an Irish, transdisciplinary youth mental health service were analyzed and illustrated according to the Seven-Eyed model of supervision. Results offer empirical support regarding the model’s relevance for supervision practice, provide practice-based evidence to elaborate aspects of the model, and show the model’s value in identifying areas of practice that may benefit from development. Illustrations of some supervision exchanges are shared which contribute to our understanding of the complexity of working at the personal-professional boundary, particularly in workplace, transdisciplinary supervision involving dual roles.
... Tomlinson [12] also argued that if CS is to be recommended, the packaging should be clarified whereas, several researchers have attempted to conceptualize CS as senior clinicians overseeing and guiding the practice of less experience clinicians. [13][14][15] The study thus, explored the benefits and challenges of administrative CS of supervisors who are usually ward managers (ward in-charges) in the unit. ...
Article
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Objective: To explore the benefits and challenges of administrative clinical supervision at the unit.Methods: Clinical Supervision has been recognised as a core component of professional support for present-day nursing and midwifery practice. Effective administrative clinical supervision is beneficial to employees by providing support leading to the development of self-esteem, reducing emotional stress and improving commitment to an organisation’s vision and goals. Using aesthetic phenomenological approach, nurses' lived experience with administrative clinical supervision in a clinical unit of the hospital was explored and allowed in-depth description of administrative clinical supervision thoroughly. The participants were purposively sampled from six hospitals in Accra and comprised supervisors (n = 18) and supervisees (n = 12).Results: The benefits of administrative clinical supervision include reduction in infection rates, improved competence, client satisfaction, reduction in negligence, efficiency, accountability and feeling of being appreciated. Challenges of administrative clinical supervision were managerial challenges, limited time, interpersonal conflict with colleagues, and increased workload.Conclusions: Practical Implications: Administrative clinical supervision has implications for nursing and midwifery education and practice. This calls for measures that promote practitioners’ personal and professional development through fostering a supportive relationship and working alliance. Originality: This study employed the use of Aesthetic Phenomenology to tell the stories of clinical supervision from the personified interpretations unlike other studies that simply adopt descriptive phenomenology. It is the first of its kind in Ghana to the best of our knowledge.
... Many organizations are seeing the benefits to staff and the quality of care and service for their clientele with supervision and mentorship programs. Dawson et al. (2013) completed a systematic review of clinical supervision within allied health professions and reported the several perceived benefits for staff receiving the supervision, such as the development of skills to support the quality and safety of client interventions, as well as increased professional accountability, well-being, coping skills, job satisfaction and retention, and reduced stress levels. Again, many of these competencies extend beyond discipline-specific competencies to encompass more general professional skills. ...
Article
In the recreation sector there is concern for ensuring that students and practitioners have adequate knowledge and skills to contribute to its growth and sustainability. While other researchers have identified the importance of personal attributes (i.e., ‘soft’ skills) for entry-level practitioners, there has been limited exploration of how peer assisted learning might contribute to preparing recreation students for their future professional practice. Recreation students from three different courses who were involved in a leisure education-based peer learning project participated in the study. Three themes were constructed to reflect students’ perceptions: (1) benefits of peer learning for preparing for future practice, 2) practice for real life, and (3) factors impacting abilities to facilitate peer learning. The results are discussed in relation to the role of peer learning or mentoring in cultivating personal and professional growth and development in and for the recreation sector.
... Most (22) were supervisors, and 14 were not. The majority of the participants were women (27; 75%) aged an average of 33 years (SD 11; range, min-max, 22-64); 12 (33%) were classified as Grade 1, 16 (44%) as Grade 2, and 8 (22%) as Grade 3. The average time that they had received clinical supervision was 4.6 years (SD 4.6; range, min-max, 0. [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. By the time the training program ended, all participants had received or provided clinical supervision and had sufficient opportunity to put their supervision training into practice. ...
Article
Purpose: The purpose of this study was to evaluate change in the effectiveness of clinical supervision of physiotherapists who took part in a clinical supervision training programme. Method: Our pre–post study design used both quantitative and qualitative methods. The programme consisted of three interactive sessions held with physiotherapists from a metropolitan public health network in Melbourne, Victoria, Australia. The effectiveness of clinical supervision of supervisees was measured using the Manchester Clinical Supervision Scale (MCSS–26). The effectiveness of clinical supervision from the supervisors’ perspective was measured using a clinical supervisor questionnaire. The physiotherapists’ experience of participating in the training programme was then explored in focus groups. Results: A total of 36 physiotherapists participated in the training programme. Twelve weeks later, the physiotherapists (35) reported a moderate improvement in the effectiveness of clinical supervision, with a mean improvement of 5.4 units (95% CI: 2.0, 8.9; p = 0.003) on the MCSS–26 (score range 0–104). After training, a higher proportion of physiotherapists reported receiving effective clinical supervision (97% after vs. 53% before; p = 0.001). In the focus groups, the physiotherapists reported greater flexibility in their approach to clinical supervision and a more effective supervisory relationship. However, difficulty finding time for supervision remained a barrier. Conclusions: Physiotherapists reported an improvement in the effectiveness of clinical supervision after a clinical supervision training programme.
... Simultaneously, it offers practitioners opportunities to explore the broader social justice implications of their work, enabling development of collective identities while countering the impacts of structural pressures, such as the increased pace and volume of work, and erosion of autonomy and discretion (Baines et al., 2014). Supervision may also contribute to organisational and workforce priorities by providing a forum for discussing values, protocols, and standards of practice (Davys & Beddoe, 2010;Dawson et al., 2013). International studies across social service contexts (Mor Barak et al., 2009), including those in child welfare (DePanfilis & Zlotnik, 2008;Williams, 2018) and mental health (Fukui et al., 2019), show supervision is a critical contributor, albeit not the sole contributor, to workforce retention. ...
Article
The contribution professional supervision makes to quality services, staff satisfaction, and retention is well recognised across social work and human service settings. Yet frequent supervision is difficult to provide where organisational resources are limited and urgent client-related tasks must take priority. In these contexts, group-based supervision may offer an alternative to traditional individual approaches, yet its impacts have been infrequently researched. Using survey data (n = 917), we examine the prevalence of individual and group-based supervision among practitioners delivering domestic and family violence and sexual assault services (DFVSA), and associations these forms of supervision have with staff retention. While individual supervision remains most common, one in eight practitioners report that they never receive it. Multivariate analysis indicates frequent individual supervision is most effective for retaining practitioners. This provides empirical support for prioritising individual supervision within strategies for promoting workforce sustainability and service quality in DFVSA and other social service settings. IMPLICATIONS • Individual supervision remains more common than group-based approaches in domestic and family violence and sexual assault services. • Workplaces should consider prioritising individual supervision over group supervision when attempting to improve practitioner retention. • Managers should adopt a critical stance and consider evidence when assessing the implications of adopting group-based approaches to supervision.
... Although the Chinese government has tried a series of initiatives to control the soaring health expenses since 2009, the people did not benefit that much due to the persistent existence of various medical misconducts, [34,35] which motivated Chinese government to seek further methods to eradicate overtreatment and misconducts since 2016. [36] Previous studies have demonstrated that clinical supervision of health professionals could not only improve quality of care, [37][38][39][40] but also controlled the medical expenses. [41] Therefore, the medical supervision platform in Sichuan province was established to real-time audit medical behaviors, especially over-treatments evoked by improper intends. ...
Article
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To address the remaining medical misconducts after the zero-makeup drug policy (ZMDP), e.g., over-examinations, China has given the priority to government supervision on medical institutions. This study evaluated the effect of government supervision on medical costs among inpatients with chronic obstructive pulmonary disease (COPD) in Sichuan province, the first province in China where the medical supervision was conducted. A linear interrupted time series (ITS) model was employed to analyze data about 72,113 inpatients from 32 hospitals. Monthly average medicine costs, diagnostic costs, and medical services costs, nursing costs from January 2015 to June 2018 were analyzed, respectively. The average hospitalization costs fell with a monthly trend of 42.90Yuan before the implementation of supervision (P < .001), and the declining trend remained with the more dramatic rate (−158.70Yuan, P < .001) after the government audit carried out. For western medicine costs, the monthly decreasing trend remained after the implementation of supervision (−66.44Yuan, P < .001); meanwhile, the monthly upward trend was changed into a downtrend trend for traditional Chinese medicine costs (−11.80Yuan, P = .009). Additionally, the increasing monthly trend in average diagnostics costs disappeared after government supervision, and was inversed to an insignificant decreasing trend at the rate of 26.18Yuan per month. Moreover, the previous upward trends were changed into downward trends for both medical service costs and nursing costs (P = .056, −44.71Yuan; P = .007, −11.17Yuan, respectively) after the supervision carried out. Our findings reveal that government supervision in Sichuan province was applicable to curb the growth of medical costs for inpatients with COPD, which may reflect its role in restraining physicians’ compensating behaviors after the ZMDP. The government medical supervision holds promise to dismiss medical misconducts in Sichuan province, the experience of which may offer implications for other regions of China as well as other low- and middle-income countries.
... 8 Proctor's model provides a framework for clinical supervision and has been adopted by health professionals, including physiotherapists. 9,10 Research has proposed that effective clinical supervision should sup port therapists in all three domains. 11 The model of clinical supervision used by physiother apists can vary. ...
Article
Purpose: We explored physiotherapists’ perceptions of clinical supervision. Method: Individual semi-structured interviews were conducted with a purposive sample of 21 physiotherapists from a public hospital. Qualitative analysis was undertaken using an interpretive description approach. The Manchester Clinical Supervision Scale (MCSS–26) was administered to evaluate the participants’ perceptions of the effectiveness of the clinical supervision they had received and to establish trustworthiness in the qualitative data by means of triangulation. Results: The major theme was that the content of clinical supervision should focus on professional skill development, both clinical and non-clinical. Four subthemes emerged as having an influence on the effectiveness of supervision: the model of clinical supervision, clinical supervision processes, supervisor factors, and supervisee factors. All sub-themes had the potential to act as either a barrier to or a facilitator of the perception that clinical supervision was effective. Conclusions: Physiotherapists reported that clinical supervision was most effective when it focused on their professional skill development. They preferred a direct model of supervision, whereby their supervisor directly observed and guided their professional skill development. They also described the importance of informal supervision in which guidance is provided as issues arise by supervisors who value the process of supervision. Physiotherapists emphasized that supervision should be driven by their learning needs rather than health organization processes.
... Social work, counselling, psychology, psychiatric nursing and psychiatry were all included for study. However, reviews were excluded that combined both social and medical services (Cutcliffe, Sloan, & Bashaw, 2018;Dawson, Phillips, & Leggat, 2013;Ducat & Kumar, 2015;Farnan et al., 2012), focused exclusively on medical services (Snowdon, Leggat, & Taylor, 2017), relied primarily on a noncounselling/psychotherapy database (e.g. learning disabilities; Milne & James, 2000) or were primarily scoping (e.g. ...
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What do clinical supervision research reviews across the last 25 years tell us? That question is subsequently examined. Based on database and literature searches, 20 reviews appearing from 1995 through 2019 were identified for survey examination; consistencies, inconsistencies and other defining features were determined across reviews; and the survey findings and their implications are considered. Primary findings are as follows: (a) ‘proof’ for supervision appears to be more ‘proof by association’ than otherwise, being primarily a product of ex post facto, cross‐sectional, correlational study; (b) evidence supporting supervision impact of any type is weak at best, especially so for worker and client outcomes; (c) supervision models generally lack empirical foundation; (d) evidence‐based supervision appears to be more a hope and dream than supervision‐based reality at present; and (e) the primary methodological problems that plagued supervision research in the 1990s are still all too frequent problems that plague supervision research now. Some questions to entertain about supervision going forward, and some remedies for improving its research, are proposed.
... Supervision in healthcare is a context-dependent practice with multiple definitions, and is generally regarded a core part of assuring and improving quality of patient care [1][2][3][4][5][6][7]. Supervision may be distinguished based on its content of normative functions on one hand (ensuring standards of services), and formative and restorative functions on the other (enabling providers by supporting professional and personal development) [8]. ...
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Background External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. Aim To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. Design Qualitative, exploratory study. Data Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. Results Evaluative activities occupied providers’ understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers’ uncontested accounts that systematic performance evaluations predominated supervisors’ work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. Conclusion While external supervisors intended to support providers’ professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.
... As part of the process of ensuring quality of care, clinical supervision has been widely implemented throughout health services [1][2][3]. Many studies have conceptualised clinical supervision of health professionals as senior clinicians overseeing and guiding the practice of less experienced clinicians [1,2,4]. ...
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Background To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience. Methods Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience. Results Seventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience. Conclusions Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health outcomes. While few studies found a direct effect on patient health outcomes, when provided to mental health professionals clinical supervision may be associated with a reduction in psychological symptoms of patients diagnosed with a mental illness. There was no association found between clinical supervision and the patient experience. Review Registration CRD42015029643. Electronic supplementary material The online version of this article (10.1186/s12913-017-2739-5) contains supplementary material, which is available to authorized users.
... The focus of the reviews included a broad range of nursing interventions and included few studies pertaining to nursing supervision specific to the practice of mental health therapy. Dawson, Phillips and Leggat (2013) broadened the population of their review to include all allied health professions, however, similarly they did not focus on mental health therapy. ...
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The primary objectives of this review are to summarize and synthesizes the available evidence on the effects of supervision for enhancing the clinical and multicultural competencies of mental health professionals. The specific research questions guiding our review include: 1) What effect does clinical supervision (versus peer consultation or no supervision) have on mental health professionals’ clinical competencies (i.e., knowledge, skill, attitude & clinical behaviour) in the practice of mental health therapy? 2) What effect does clinical supervision (versus peer consultation or no supervision) have on mental health professionals’ multicultural competencies (i.e., knowledge, skill, attitudes and clinical behaviour) in the practice of mental health therapy? 3) What effect does clinical supervision (versus peer consultation or no supervision) have on the health outcomes of patients/clients participating in supervised mental health therapy? The secondary objectives of this review include: Identifying the key experiences of supervisees and/or supervisors with the supervision process that help identify any reasons why clinical supervision may succeed or fail in improving clinical and/or multicultural competencies in mental health professionals and/or succeed or fail in improving health outcomes for patient/clients participating in mental health therapy.
... When a comparison was made between a nursing skills laboratory, standardized patient 2 laboratory and clinical practice for the development of students' clinical competence, it was observed that students' psychomotor 3 and communication skills increased more with each upgrade of the clinical learning environment towards authentic clinical settings (Terzioglu et al. 2016). In real clinical settings students gain a deeper understanding of the importance of providing equal rights and good quality healthcare towards patients (Act on the Status and Rights of Patients 785/1992) while assuring patient safety (Health Care Act 1326, Patient Safety Regulation 341/2011, Dawson et al. 2013, Lukewich et al. 2015, Stevanin et al. 2015, Tella et al. 2015, Walton & Barraclough 2016. ...
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The purpose of this study was to describe perceptions and explain background factors relating to the clinical learning environment and mentoring of culturally and linguistically diverse nursing students. The study included two phases: instrument development and a cross-sectional study. The instrument development phase consisted of a conceptualization process, which included two systematic reviews with thematic synthesis; generation of items for two new instruments, Cultural and Linguistic Diversity scale and Cultural and Linguistic Diversity in Mentoring scale, and psychometric testing of these newly developed scales. The cross-sectional phase was completed by collecting data from: (a) students (n = 329) studying in English-language nursing degree programmes from eight Finnish universities of applied sciences during autumn 2015 and spring 2016; and (b) mentors (n = 323) of culturally and linguistically diverse students from five Finnish university hospitals during spring 2016. In addition to the two newly developed instruments, two commonly used instruments Clinical Learning Environment, Supervision and Nurse Teacher scale and Mentors’ Competence Instrument were used for the main data collection. The data was analyzed using descriptive statistics, a nonparametric test and a binary logistic regression analysis. The psychometric properties of the instruments had good validity and reliability. Students’ perceptions on the level of their clinical learning environment and mentoring were lower than their mentors’ perceptions of their own mentoring competence. The level of language was the most common factor relating to the outcomes of culturally and linguistically diverse students’ clinical learning environment and mentoring. Future studies on culturally and linguistically diverse nursing students in the clinical environment should have a marked emphasis on improving proficiency in the native language, which should be implemented in the organizational structure of the clinical placements. This should include providing additional education for clinical mentors to enhance their mentoring competence with culturally and linguistically diverse students.
... 5,6 Evidence of benefits of supervision to health professionals are well-documented, including supporting those working in isolation, assisting staff to cope better in their roles, reduced burnout and developing knowledge and competence. [7][8][9][10] For organisations, supervision improves multidisciplinary teamwork, enables the development of clinical standards and enhances the quality of service delivery. 11 Clinical supervision is an important mechanism for professional support of health practitioners. ...
Article
Introduction Whilst telesupervision (clinical supervision undertaken using communication technology) is being used more frequently, there is limited information on what factors influence its effectiveness and quality. We undertook this systematic review to address this gap. Methods Eligible telesupervision studies were identified following targeted search of electronic databases and the grey literature. Data were synthesised thematically, resulting in development of core themes. Results We identified 286 papers for initial relevancy screening by title and abstract. The full text of 36 papers were then retrieved and assessed for further relevance. A total of 11 papers were included in the final analysis. We identified eight themes that contribute to effective and high-quality telesupervision: supervisee characteristics, supervisor characteristics, supervision characteristics, supervisory relationship, communication strategies, prior face-to-face contact, environmental factors and technological considerations. Conclusion From the available evidence, telesupervision can be a feasible and acceptable form of clinical supervision if set up well. Further studies with robust designs are required to strengthen the existing evidence on what makes telesupervision effective, as well as to examine its cost-effectiveness.
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Abstrakt Background: In the ever-evolving environment of healthcare, the continuous professional development of healthcare workers and ensuring the high quality of patient care have become increasingly important. Clinical supervision, defined as 'the provision of guidance for clinical practice to qualified healthcare professionals by a more experienced health professional', has emerged as a key instrument in achieving these objectives. Objective: This abstract outlines a review study aimed at examining the impact of clinical supervision on healthcare professionals' professional growth and the quality of care provided. The study focuses on identifying and analyzing existing evidence on how supervisory processes contribute to professional development and the optimization of patient care. Methods: A systematic literature review of relevant databases, including PubMed, Scopus, and Web of Science, was conducted. Selection criteria included studies focused on clinical supervision in healthcare, with a primary emphasis on qualitative outcomes related to professional growth and quality of care. Data were extracted, synthesized, and analyzed using thematic analysis. Results: The findings indicate that clinical supervision has a positive impact on clinical practice, including the enhancement of self-confidence, clinical reasoning, and interdisciplinary communication among healthcare professionals. Additionally, supervision was found to contribute to safer and more effective patient care, resulting in better patient outcomes and increased patient satisfaction. Conclusion: Clinical supervision is an essential element for fostering professional growth and enhancing the quality of healthcare. This study supports the integration of supervisory processes into practice as a strategy for continuous education and care improvement, and advocates for further research focused on the quantitative evaluation of the impact of clinical supervision.
Article
Clinical supervision typically occurs between clinicians who are trained in the same discipline, and this assumption is present across much of the relevant literature. However, the use of interprofessional supervision (IPS), wherein clinicians do not share the same discipline, has increased in recent years. As IPS increases in usage, it is key that the implications of this approach are explored. In order to map the existing evidence, a scoping review was conducted to explore what is known about the use of IPS across five allied health professions (psychology, speech and language therapy, occupational therapy, physiotherapy and social work). A systematic literature search of four electronic databases was conducted, with 27 articles meeting the inclusion criteria. The data were analyzed using thematic synthesis. Six key themes were identified relating to factors impacting the appropriateness of IPS, necessary steps in the IPS process, and impacts of IPS for clinicians. Limited application of standardized tools and theoretical frameworks within the existing research was highlighted. The findings identified within this review present a broad overview of the existing research relating to IPS, which can be used to inform future research in this area.
Chapter
Šis rakstu krājums ir Rīgas Stradiņa universitātē uzsākto rakstu krājumu par supervīzijas specifiku dažādās profesionālajās vidēs otrais izdevums. Izdevums veltīts supervīzijai veselības aprūpē. Tā mērķis ir vairot lasītāju izpratni par supervīzijas lietderību veselības aprūpes speciālistu profesionālās pilnveides un labbūtības nodrošināšanā, kā arī veicināt supervīzijas kā mērķtiecīgi plānota un organizēta procesa iekļaušanu profesionāļu darba ikdienā.
Article
Question: Does adding an interactive clinical supervision training program to self-education improve the effectiveness of clinical supervision of physiotherapists, reduce burnout, decrease intention to leave and increase participation in clinical supervision? Design: Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Physiotherapists (n = 58) working at a publicly funded health service. Intervention: Participants in both groups received a self-education clinical supervision training package. In addition, participants in the experimental group received interactive clinical supervision training consisting of three 90-minute workshops. Outcome measures: The primary outcome measure was effectiveness of clinical supervision 4 months after training measured using the Manchester Clinical Supervision Scale (MCSS-26). Secondary outcomes were the Maslach Burnout Inventory, the Intention to Leave Scale, and participation in supervision. Focus groups were also used to gauge impressions of the intervention. Results: The addition of interactive clinical supervision training slightly improved effectiveness of clinical supervision, with a between-group mean difference of 6.3 units (95% CI 0.3 to 12.3) on the MCSS-26. The estimate of the effect on the proportion of physiotherapists reporting effective clinical supervision (ie, MSCC-26 score ≥ 73) was unclear (OR 1.97, 95% CI 0.50 to 7.81). Physiotherapists in the experimental group reported slightly lower levels of depersonalisation (MD –3.0 units, 95% CI –4.6 to –1.3). There were negligible or uncertain effects on the other burnout domains, intention to leave and participation in clinical supervision. Qualitatively, participants reported that the workshops made them realise that supervisees could take greater ownership of where supervision focused. Conclusion: Adding interactive clinical supervision training to self-education leads to small improvements in the effectiveness of clinical supervision of physiotherapists.
Article
Aim: This peer-mentoring concept analysis aimed to explore and define the concept of peer mentoring in nursing education and the impact it may have on nursing education. Background: A lack of literature exists explicitly defining peer mentoring in nursing education. The interchangeable use of processes, terms, and applications may contribute to the lack of consistency and obscurity of nursing education scholarship on peer mentoring. Since peer mentoring can be used to enhance student success, there is a need to clarify the concept of peer mentoring in nursing education for accuracy in future nursing education research. Design/review method: Using Walker and Avant's framework, the authors identified defining attributes, antecedents, and consequences of peer mentoring. Data source: The literature search involved a combination of terms in the MEDLINE with Full Text, Academic Search Complete, Humanities International, ERIC, CINAHL, Health Source: Nursing/Academic Edition, and Consumer Health Complete-EBSCOhost databases. Results: This concept analysis revealed a consistent definition of peer mentoring for use in nursing education. The definition of peer mentoring in nursing education is a formal learning partnership between two individuals (mentor and mentee) with differing levels of nursing school experience. The peer mentor promotes a positive academic and emotionally supportive environment, decreasing stress and increasing the mentee's confidence and competency. Conclusion: A shared definition and understanding of peer mentoring within nursing education can contribute to the consistent use of the concept in research and advance the scholarship of nursing education.
Article
Objective: The primary objective of this review is to identify how allied health staff have used mentoring as a knowledge translation strategy to support practice change. Secondary objectives include identifying barriers and enablers to using mentoring as a knowledge translation strategy, and the methods used to evaluate the strategy. Introduction: Mentoring provides professional support and guidance whilst attending to the learning needs of the individual. Mentoring has been described in previous knowledge synthesis reviews as a strategy for nursing and medicine practitioners to improve capability and capacity to participate in knowledge translation to create practice change. To the authors' knowledge, a synthesis of the use of mentoring as a knowledge translation strategy by allied health staff has not been reported. Inclusion criteria: This scoping review will consider all studies that describe the use of mentoring with allied health staff to support practice change as directed by research evidence. The scoping review will not investigate the use of mentoring to increase the conduct of research in a clinical setting, nor will studies be included if the majority of participants are students. Methods: A three-step search strategy will be undertaken. Two independent authors will screen articles and perform data extraction. The results will be presented in a narrative Summary of Findings, alongside a presentation of the data in diagrammatic or tabular form. The findings will inform future use of mentoring as a knowledge translation strategy in a regional health service.
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Background Schwartz Center Rounds ® (Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry . London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care. Objectives How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care. Design (1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation). Setting (1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey). Participants (1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings. Results (1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly ( p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work. Limitations Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds. Conclusion Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues. Future work The adaptation of Rounds to new contexts and to increase reach needs evaluation. Funding The National Institute for Health Research Health Services and Delivery Research programme.
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The growing importance of clinical supervision makes it timely to formulate and pilot an evidence-based approach. This entails specifying a rationale for supervision skills that is grounded in research evidence and enjoys a consensus amongst supervisors, implementing an educational system to develop those skills, and evaluating the effectiveness of this approach. The present study tackles these tasks by detailing an evidence-based approach to clinical supervision; by implementing regular consultancy sessions to try and develop one supervisor's competence; and by evaluating (within a multiple baseline design) the effectiveness of these sessions and the clinical supervision provided to three supervisees. Based on systematic observations of 30 supervision sessions conducted over an 8-month period, the results indicated that the consultancy led to modest improvements in the supervision. The supervision was highly rated by the supervisees throughout the study period. Implications are drawn for developing evidence-based supervision, emphasizing the instructional and methodological components. Copyright © 2001 John Wiley & Sons, Ltd.
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The empirical studies in clinical supervision published from 1981 through 1993 were investigated to assess scientific rigor and to test whether the quality of methodology had improved since the review by R. K. Russell, A. M. Crimmings, and R. W. Lent (1984). The 144 studies were evaluated according to 49 threats to validity (T. D. Cook & D. T. Campbell, 1979; R. K. Russell et al., 1984; B. E. Wampold, B. Davis, & R. H. Good III; see record 1990-28928-001) and 8 statistical variables (e.g., effect size, statistical power, and Type I and Type II error rates). The data revealed a shift to realistic field studies, unchecked Type I and Type II error rates, medium effect sizes, and inattention to hypothesis validity. Recommendations for designing and conducting a feasible and well-designed supervision study are offered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Clinical supervision is an integral aspect of training and is essential for accreditation as a cognitive behavioural psychotherapist. A questionnaire survey of a random sample of accredited British Association of Behavioural and Cognitive Psychotherapists (n = 280) is reported, 61% (N = 170) responded by describing their supervision practices in a number of areas. These included the organization of supervision, content, satisfaction, techniques, models, interdisciplinary working and supervision of others. The results indicate that satisfaction levels with supervision were high amongst accredited therapists and that the ratio of time spent in supervision to therapeutic contact is, on average, higher than recommended minimum levels. Supervision was less structured and active than therapy and little use was made of audio/video tapes of therapy sessions within supervision. The level of training for supervisors was highly variable with a substantial proportion having received no formal training in cognitive behavioural psychotherapy supervision. Dual role relationships were also common. Finally, recommendations for further research and practice are made.
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Objective: Clinical supervision (CS) is attracting attention in the Australian nursing context with efforts underway to embed CS into mental health settings and to extend it to the general nursing population. The purpose of this paper is to review the available evidence regarding the effectiveness of CS in nursing practice in order to inform these efforts. Method: Relevant literature was located by first accessing research articles in peer-reviewed publications that related to CS and nursing. A total of 32 articles were retrieved. In selecting articles for review, the following criteria were then applied: the article reported an evaluation of the effectiveness of CS; the participants in the study included qualified nurses (not students or generic health care workers); the approach to CS was clearly described; and, the method of data collection and analysis, either quantitative and/or qualitative, was explained in detail. Results: Of the 32 studies identified in the literature 22 studies met the inclusion criteria. One feature that differentiated the studies was research method, for example, pre-post design; and, articles were initially grouped by method. The reported outcomes of the studies were then categorised according to Proctor's three functions of CS. The results of the studies demonstrated that all three functions, restorative, normative and formative, were evident. The restorative function was noted slightly more frequently than the other two functions. Conclusions: There is research evidence to suggest that CS provides peer support and stress relief for nurses (restorative function) as well a means of promoting professional accountability (normative function) and skill and knowledge development (formative function).
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The objective of this paper was to systematically review and critically evaluate all English language research papers reporting empirical studies of clinical supervision in psychiatric nursing. The first part of the search strategy was a combination of brief and building block strategies in the PubMed, CINAHL, and PsycINFO databases. The second part was a citation pearl growing strategy with reviews of 179 reference lists. In total, the search strategy demonstrated a low level of precision and a high level of recall. Thirty four articles met the criteria of the review and were systematically evaluated using three checklists. The findings were summarized by using a new checklist with nine overall questions regarding the studies' design, methods, findings, and limitations. The studies were categorized as: (i) effect studies; (ii) survey studies; (iii) interview studies; and (iv) case studies. In general, the studies were relatively small scale; they used relatively new and basic methods for data collection and analysis, and rarely included sufficient strategies for identifying confounding factors or how the researchers' preconceptions influenced the analyses. Empirical research of clinical supervision in psychiatric nursing was characterized by a basic lack of agreement about which models and instruments to use. Challenges and recommendations for future research are discussed. Clinical supervision in psychiatric nursing was commonly perceived as a good thing, but there was limited empirical evidence supporting this claim.
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There have recently been several organizational changes that have challenged nursing managers in the Finnish health care system. First-line managers need support in their work because of organizational changes and scarce economic resources. One of these supportive measures is clinical supervision. A group of first-line managers in a Finnish University hospital participated in a 2-year clinical supervision intervention in 1999-2000. The managers' perceptions of the clinical supervision were followed up twice during the intervention and 1 year after (2001). The aim of this study is to describe how the first-line managers saw the future effects of the clinical supervision intervention 1 year after its termination. At the beginning of the intervention, the number of participating nursing managers was 32. The number of respondents in this study 1 year (2001) after the clinical supervision was 11. Data was collected using empathy-based stories, which involved writing short essays. The respondents received orientation and a script to assist them in the writing of essays. The stories were analysed qualitatively by categorizing the responses by themes. The managers deemed that clinical supervision had, in the 3-year time frame, positive long-term effects on their leadership and communication skills, the desire for self-development, self-knowledge and coping. Managers believed that in the long run, clinical supervision would provide them with a broader perspective on work and would enhance the use of clinical supervision as a supportive measure among co-workers. First-line managers expect clinical supervision to have long-term positive effects on their work and coping. Empathy-based stories, as a method, were found suited to studies, which aim to obtaining future-oriented knowledge.
Article
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.
Article
This paper reports on an exploration of the concept of ‘supervision’ as applied to allied health professionals within a large mental health service in one Australian State. A two-part methodology was used, with focus group interviews conducted with allied health professionals, and semi-structured telephone interviews with service managers. Fifty-eight allied health professionals participated in a series of seven focus groups. Semi-structured interviews were conducted with the Directors or Managers of mental health services in all 21 regions in the state.Allied health professionals and service managers both considered supervision to be an important mechanism for ensuring staff competence and best practice outcomes for consumers and carers. There was strong endorsement of the need for clarification and articulation of supervision policies within the organization, and the provision of appropriate resourcing to enable supervision to occur. Current practice in supervision was seen as ad hoc and of variable standard; the need for training in supervision was seen as critical. The supervision needs of newly graduated allied health professionals and those working in rural and regional areas were also seen as important. The need for a flexible and accessible model of supervision was clearly demonstrated.
Article
Background: Midwives' different leadership and supervisory styles influence women's experiences of childbirth in various ways. Aim: The aim of this study was to evaluate midwives' experiences of group supervision and the influence of the continuity of care model, with particular focus on childbearing women's need for emotional support. An additional aim was to evaluate the development of the midwives' professional competence. Methods: Qualitative thematic analysis was used to analyse the notes made during the supervision sessions and focus group discussion. Results: The significance of the midwives' continuity of care model was: assessment of the women's individual needs, enabling strategies to create a deeper relationship and acknowledging the vulnerability in the relationship with the women. The outcome of the midwives' group supervision was increased professional competence. Three themes emerged: Integrating science into midwifery practice, Awareness of one's professional role and Sensitivity in one's professional role. Conclusions: These findings provide a clear indication that the women's need for emotional support can be fulfilled by the midwives' leadership. Implication for nursing management: The development of the midwife's role as a leader in maternity care is closely related to the opportunities for the provision of supervision aimed at increasing her professional competence.
Article
The objective of this study was to test a model for analysing the possible benefits of clinical supervision. The model suggested a pathway from participation to effectiveness to benefits of clinical supervision, and included possible influences of individual and workplace factors. The study sample was 136 nursing staff members in permanent employment on nine general psychiatric wards and at four community mental health centres at a Danish psychiatric university hospital. Data were collected by means of a set of questionnaires. Participation in clinical supervision was associated with the effectiveness of clinical supervision, as measured by the Manchester Clinical Supervision Scale (MCSS). Furthermore, MCSS scores were associated with benefits, such as increased job satisfaction, vitality, rational coping and less stress, emotional exhaustion, and depersonalization. Multivariate analyses indicated that certain individual and workplace factors were related to subscales of the MCSS, as well as some of the benefits. The study supported the suggested model, but methodological limitations apply.
Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in group-based supervision and identifying psychosocial reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses.
Article
A discussion of clinical supervision to enhance existing support structures such as preceptorship and mentorship to positively influence the recruitment and retention of newly graduate nurses provides the main focus for this paper. The nursing literature provides evidence for alternative but equally worthy perspectives on clinical supervision. Essential to the successful practice of clinical supervision is the need to ascertain whether it is simply a system to ensure an effective workforce or one that will empower nurses to realise their vision of nursing.
Article
The relationships between, on the one hand, burnout, empathy and sense of cohoerence (SOC) and, on the other, personality traits were investigated, together with the effects of systematic clinical supervision on these phenomena among Swedish district nurses. The results in the supervisory group (n = 21) were compared with those of a comparison group (n = 12) in a quasi-experimental design. Personality traits were assessed by means of the Karolinska Scales of Personality. The results indicated some correlations between personality traits and burnout, empathy, and SOC, as well as correlations between the latter three phenomena. There were no significant effects of clinical supervision on burnout, empathy, or SOC. More research is needed regarding the effects of clinical nursing supervision.
Article
An exploratory study, funded by the Department of Health, London and the Scottish Home and Health Department, Edinburgh, was conducted over an 18-month period to provide an informed view on possible assessment tools that could be used to assess the impact of clinical supervision (CS) in nursing and to report on the CS activities in 23 selected sites in England and Scotland. The study not only examined the utility of several standardized research instruments, to be reported separately, but also explored the experience of a small sub-sample of nurses (n = 34) engaged in CS, as supervisors and supervisees. Interviews were undertaken to help better understand some of the issues involved around the domains of structure, process and outcome. Respondents reported an enthusiasm for the opportunity to talk meaningfully to a trusted colleague about their personal circumstances at work. Such opportunities were particularly welcomed by nurses who wished to reflect upon their own practice with patients, especially when dealing with their clinical conditions which were upsetting, or otherwise challenging, and sometimes harrowing. Substantive and methodological areas of interest for future research are suggested.
Article
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.
Article
To investigate nurses' satisfaction with their work environment and moral stress levels as effects of systematic clinical nursing supervision. Nurses have identified high workload, low influence over work assignment, limited avenues for skills development and diminishing support from supervisors as sources of considerable tension resulting in deterioration of work conditions and decreased job satisfaction. This study is a descriptive-correlational study. Data were analysed by means of descriptive statistics. The major result indicates moral stress in the workplace. It was found that a significant relationship existed between moral sensitivity and systematic nursing clinical supervision. The results point to the need to support nurses in developing personal qualities, integrated knowledge and self-awareness, which is in line with the effects of clinical nursing supervision reported in other studies.
Article
The aim of this article is to explore the current state and challenges of clinical supervision with regard to its research. Clinical supervision in nursing has been debated extensively, but also accepted officially as part of nursing practice. However, it has been claimed that the subject is conceptually vague, theoretically ambiguous and lacking in empirical research evidence. A computer-based search was carried out in an international journal database of nursing. Of the published articles on effectiveness, 11 were chosen for a closer examination. It can be argued that the present studies have failed to show actual effects of clinical supervision reliably and convincingly enough. Research into supervisory effectiveness is still in its infancy. To increase the scientific rigour of future research, it would be necessary to expand and clarify the scope of these studies as well as to diversify the range of research methods on the basis of ontological and epistemological analyses.
Article
•There is little research evidence to suggest that clinical supervision reduces stress. However, this probably does not mean that clinical supervision is not valuable, just that the evidence is not yet there, because consensus exists that group clinical supervision may be beneficial in reducing stress in nurses. •The work by Butterworth et al . is the only directly relevant study investigating the stress‐reducing potential that a group approach to clinical supervision has, and this work establishes ground rules for future evaluation.
Article
As hospitals attempt to decrease their costs to survive in today's health care market, they are implementing resizing strategies that promise greater efficiency. A by-product has been the elimination of many management and supervisory positions. A self-administered questionnaire was sent to a stratified random sample of 750 hospitals (yielding a 46% return rate) to study the types of supervisory models being utilized and the factors associated with their differential use. While concern is expressed about the erosion of clinical supervision, the data suggests that the majority of social workers are receiving supervision from a social worker.
Article
Increased workload in primary care and the advent of primary care groups means that practice nurses (PNs) are experiencing a profusion of changes. As a result, PNs have taken on board many new skills, and this has increased the demands and stresses made upon them. Accordingly, this study investigated 17 PNs' lived experiences of clinical supervision following a 4-day training programme. It adopted a hermeneutic, phenomenological method. Data were collected by means of semistructured interviews within a series of focus groups. The data from the focus groups underwent a thematic analysis, which induced an emerging theory comprising five key themes: (1) providing support (2) nurturing and growth (3) enhancing and enriching practice (4) encountering a new experience, and (5) engaging in intellectually challenging and demanding work. The findings indicated that the central theme of the PNs' experience of clinical supervision was that of 'providing support', in that, without the presence and application of support, the effectiveness of the other themes appears to be diminished. The findings additionally indicated a range of issues, discussed under the headings: practice, education, policy, and further research.
Article
This study examined whether supervision characteristics impacted on mental health practice and morale, and developed a new Supervision Attitude Scale (SAS). Telephone surveys were conducted with a representative sample of 272 staff from public mental health services across Queensland. Although supervision was widely received and positively rated, it had low average intensity, and assessment and training of skills was rarely incorporated. Perceived impact on practice was associated with acquisition of skills and positive attitudes to supervisors, but extent of supervision was related to impact only if it was from within the profession. Intention to resign was unrelated to extent of supervision, but was associated with positive attitudes to supervisors, accessibility, high impact, and empathy or praise in supervision sessions. The SAS had high internal consistency, and its intercorrelations were consistent with it being a measure of relationship positivity. The study supported the role of supervision in retention and in improving practice. It also highlighted supervision characteristics that might be targeted in training, and provided preliminary data on a new measure.
Article
Various studies have demonstrated that nursing is stressful and that the incidence of occupational stress-related burnout in the profession is high. This descriptive-correlational study examined nurses' satisfaction with their psychosocial work environment, their moral sensitivity and differences in outcomes of clinical nursing supervision in relation to nurses' well-being by systematically comparing supervised and unsupervised nurses. Nurses were selected from two hospitals (n = 71). Data collection was by means of questionnaires and analysed by descriptive and inferential statistics. The nurses' satisfaction with their psychosocial work environment was reflected in six factors: 'job stress and anxiety', 'relationship with colleagues', 'collaboration and good communication', 'job motivation', 'work demands' and 'professional development'. The nurses' perceptions of moral sensitivity comprised seven factors: 'grounds for actions', 'ethical conflicts', 'values in care', 'independence patient-oriented care', 'the desire to provide high-quality care' and 'the desire to provide high-quality care creates ethical dilemmas'. Nurses well-being were reflected in four factors 'physical symptom and anxiety', 'feelings of not being in control', 'engagement and motivation' and 'eye strain sleep disturbance'. The moral sensitivity 'ethical conflicts' were found to have mild negative correlations with psychosocial work environment 'job stress and anxiety professional development' and with 'total score' psychosocial work, moral sensitivity factor 'independence were correlated with psychosocial work factor 'relationships with colleagues' and 'total score', moral sensitivity were mildly correlated with 'collaboration and good communication and had a negative correlation to psychosocial work factor 'work demands'. In addition, significant correlations were found between the nurses' well-being profile and demographic variables, between 'engagement and motivation' and 'absence due to illness' and between 'time allocation for tasks', 'physical symptoms and anxiety' and 'age'. Mild significant differences were found between nurses attending and not attending group supervision and between 'physical symptoms and anxiety' and 'feelings of not being in control'. We conclude that ethical conflicts in nursing are a source of job-related stress and anxiety. The outcome of supporting nurses by clinical nursing supervision may have a positive influence on their perceptions of well-being. clinical nursing supervision have a positive effect on nurses physical symptoms and their feeling of anxiety as well as having a sense of being in control of the situation. We also conclude that psychosocial work have an influence on nurses experience of having or not having control and their engagement and motivation.
Article
This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.
Article
As part of an ongoing service development programme at St Andrew's Hospital, Northampton, it was identified that it would be beneficial to explore whether qualified nursing staff in the hospital's five clinical divisions were satisfied with the clinical supervision they received. Also, the survey examined whether supervision was of good quality, was suitable for different specialist environments and if it affected motivation, skills, confidence and stress levels. The survey also explored if there was a difference between D or E-grade nurses and nurses who are F grade and above regarding their perception of clinical supervision. This included a Likert scaled questionnaire (Ladany et al, 1996); and a retrospective (ex-post-facto) cross-sectional survey design. A questionnaire and information sheet was dispatched to 50 qualified nursing staff. Ten nurses from each of the five divisions were invited to participate. After one month, 35 (70 per cent) had returned the questionnaires. Senior staff benefit more and are more satisfied with regular supervision than junior staff. The survey shows that clinical supervision is in quite good shape, with most nurses receiving regular supervision within a limited time span. Large numbers of qualified nurses receive supervision in the hospital and this is extremely positive. However, there are a number of discrepancies regarding who receives supervision, and within what time frame, and why so many qualified nurses feel the supervision is not helping them work more effectively.
Article
This paper reports a study to determine how supervisees' backgrounds and surrounding infrastructure predict the efficacy of clinical supervision among Finnish nursing staff, their job satisfaction, levels of burnout and perceptions of the quality of care. Several studies have described the effects of clinical supervision, but few have focused on evaluating it. Until recently, no studies have examined how clinical supervision evaluations are related to supervisees' backgrounds, surrounding infrastructure or respondents' levels of burnout, job satisfaction and perceptions of the quality of care. The survey involved supervisees completing a range of standardized and validated evaluation measures. The respondents were identified from 12 regional, central and university hospitals across Finland (n = 799). The data collection took place from October 2000 to February 2001. The evaluations varied statistically significantly and were associated with statistically significant variations in the respondents' backgrounds. Clinical supervision infrastructure was also strongly related to evaluation scores. Supervisees' age, education, gender, employment status, area of specialty, working hours, work experience and experience as a supervisor were statistically significant predictors for evaluations of the efficacy of clinical supervision. These evaluations of clinical supervision were also found to predict the respondents' job satisfaction, levels of burnout and assessments of good nursing. Nursing staff, especially those who have over 10 years' work experience, work in general care, have a nursing diploma, are non-tenured, work part-time and work 24-hour rotating shifts can benefit from clinical supervision. However, resources need to be invested in supervisor education and nursing staff need to be encouraged to start working in both supervisor and supervisee roles because of the positive effects on job satisfaction and quality of care.
Article
The aim of this study was to describe multidisciplinary attitudes towards/about Clinical Supervision. Clinical Supervision continues to be a matter of high interest for nurses and other health care disciplines. Despite the existence of a body of a substantive literature, gaps in our knowledge base remain. Data was collected using a form composed of 17 statements. A total sample of 74 participants completed the form and rank-ordered the statements. The sample was comprised of a mix of eight different disciplines: Registered Nurses (hospital based), Chiropodists, Occupational Therapists, Learning Disability Nurses, Registered Nurses (community based), Registered Mental Health Nurses, Health Visitors and Physiotherapists. Data were analyzed by descriptive and non-parametric statistics. The respondents' agreement was high concerning the rankings of the item (11) ''Confidentiality is assured and agreed''. Almost all respondents ranked this item as the most important characteristic for group supervision. The respondents shared almost a total agreement concerning the item (17) ''The supervisor should be a manager''. This was ranked as the least important characteristic for group supervision. The importance of having a clinical supervisory relationship that remains separate from administrative/managerial supervision and one where confidentiality is assured was highlighted by this study. Furthermore, the attitudes were not restricted to one professional or disciplinary group. The effective support system of clinical supervision should therefore not be diluted by awkward and unnecessary amalgamations with administrative/managerial supervision.
Article
The aim of this study was to make a synthesis of three studies that deal with the following research question: 'How does clinical nursing supervision enhance nurses' experiences of well-being in relation to their psychosocial work environment?' Clinical nursing supervision is one way to support nurses in coping with their stressful work situation. A hermeneutic approach was used to reflect and interpret nurses' experiences of well-being in relation to clinical nursing supervision and psychosocial work environment. The findings suggest that clinical nursing supervision has an influence on nurses' experiences of well-being and in relation to their psychosocial work environment. Nurses attending clinical nursing supervision reported increased satisfaction with their psychosocial work environment. The significance of caring and nursing becomes evident when nurses realize and understand that clinical nursing supervision positively influences their existence and well-being. The value of work becomes clear when nurses reflect on themselves as professionals and as authentic human beings in clinical nursing supervision. This will lead to the emergence of self-recognition.
Article
Clinical supervision has become an established part of nursing. Implemented in various different ways it has attracted attention from the research, educator and practice communities. The literature reported and analysed in this paper describes work that may benefit professional practice but there continue to be questions about application and method. Two new messages arise from the literature. The first underscores the responsibility of health care organisations to sustain and develop clinical supervision and the second points to the potential benefit that clinical supervision may have on patient outcomes.
Article
An intriguing hypothesis is that clinical supervision may protect against counselor turnover. This idea has been mentioned in recent discussions of the substance abuse treatment workforce. To test this hypothesis, we extend our previous research on emotional exhaustion and turnover intention among counselors by estimating the associations between clinical supervision and these variables in a large sample (N = 823). An exploratory analysis reveals that clinical supervision was negatively associated with emotional exhaustion and turnover intention. Given our previous findings that emotional exhaustion and turnover intention were associated with job autonomy, procedural justice, and distributive justice, we estimate a structural equation model to examine whether these variables mediated clinical supervision's associations with emotional exhaustion and turnover intention. These data support the fully mediated model. We found that the perceived quality of clinical supervision is strongly associated with counselors' perceptions of job autonomy, procedural justice, and distributive justice, which are, in turn, associated with emotional exhaustion and turnover intention. These data offer support for the protective role of clinical supervision in substance abuse treatment counselors' turnover and occupational well-being.