The Following Information Provides an Evidence Base for Clinical Supervision

The following information provides an evidence base for clinical supervision:

Rationale, importance and need for clinical supervision

Within nursing practice, clinical supervision is an established feature of day to day routine (Butterworth, Bell, Jackson., Maida, 2008) and particularly so within mental health and psychiatric settings (Bland & Rossen 2005; Hines-Martin & Robinson; 2006; West; 2009). Clinical supervision is widely recognised as standard practice among many of the Allied Health Professionals (AHPs) (Dawson, Phillips & Leggat . 2012) The importance of clinical supervision is also “widely promoted” within counselling and psychotherapy practice (Wheeler & Richards 2007). In the context of professional psychology training, clinical supervision too is deemed highly important and is a major investment of staff training time (Gonsalvez & Milne 2010).

The following table reflects the wider literature in health care which also presents a rationale for executing supervision.

Paper / Rationale for Supervision
Mills, J.E., Francis, K.L., Bonner, A. (2005). Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural nurses. A review of the literature. Rural & Remote Health, 5(3), 410. / Extremely important in the context of remote and rural nursing.
Chilvers, R., Ramsey, S (2009). Implementing a clinical supervision programme for nurses in a hospice setting. International Journal of Palliative Nursing. 15(12), 615 - 619. / Important in improving standards of patient care.
Hines-Martin, V., & Robinson, K. (2006). Supervision as professional development for psychiatric mental health nurses. Clinical Nurse Specialist, 20(6), 293–297. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17149020 / Within psychiatric mental health nursing, supervision supports clinical competence, quality care and professional insight. Emphasis is also placed upon reflection, self-awareness, and therapeutic use of self.
Spence, S.H., Wilson, J., Kavanagh, D., Strong, J., Worrall, L. (2001). Clinical supervision in four mental health professions: A review of the evidence. Behaviour Change, 18(3), 135 - 155. / Supervision offers graduates the ability to maintain their skills in line with current recommendations. In addition, problem solving skills, creativity, emotional awareness and confidence are promoted.
Mastoras, S. M., Andrews, J. J. W. (2011). The supervisee experience of group supervision: Implications for research and practice. Training and Education in Professional Psychology, 5(2), 102–111. doi:10.1037/a0023567 / Within psychology and counsellor training, supervision is an integral component in the delivery of services and in the delivery of continuing professional development.
Bland, A. R., Rossen, E. K. (2005). Clinical supervision of nurses working with patients with borderline personality disorder. Issues in Mental Health Nursing, 26(5), 507–517. doi:10.1080/01612840590931957 / Within psychiatric nursing, clinical supervisors oversee and are responsible for the work of nurses, as well as providing knowledge and emotional support.
Spence, S.H., Wilson, J., Kavanagh, D., Strong, J., Worrall, L. (2001). Clinical supervision in four mental health professions: A review of the evidence. Behaviour Change, 18(3), 135 - 155. / Personal aspects of supervision aims to promote motivation and may include career planning, and in coping with stress.
Sirola-Karvinen, P., & Hyrkäs, K. (2006). Clinical supervision for nurses in administrative and leadership positions: a systematic literature review of the studies focusing on administrative clinical supervision. Journal of Nursing Management, 14(8), 601–609. doi:10.1111/j.1365-2934.2006.00719.x / In clinical supervision for nurses in administrative and leadership positions, the focus is placed upon quality management.
Holloway, E. (1995). Clinical Supervision: A Systems Approach. London: Sage Publications. / An ongoing relationship that permits the supervisee to learn professional attitudes, skills and knowledge in a supportive manner (and related to the development of the supervisee as a professional).
Bland, A. R., Rossen, E. K. (2005). Clinical supervision of nurses working with patients with borderline personality disorder. Issues in Mental Health Nursing, 26(5), 507–517. doi:10.1080/01612840590931957 / Provides the opportunity for nurses to explore therapeutic techniques, attitudes and ethics, particularly during testing times.
Morgan, M. M., & Sprenkle, D. H. (2007). Toward a common-factors approach to supervision. Journal of Marital and Family Therapy, 33(1), 1–17. doi:10.1111/j.1752-0606.2007.00001.x / Outlines how supervision could support supervisee personal growth, self-awareness, autonomy and confidence.
Farnan, J. M. Petty, L. A., Georgitis, E., Martin, S. Chiu, E., Prochaska, M. & Arora, V. M., (2012). A Systematic Review: The Effect of Clinical Supervision on Patient and Residency Education Outcomes. Academic Medicine, 87(4) 428 – 442. / Enhanced attending supervision could improve patient and education-related outcomes.

The literature also notes that clinical supervision needs to be viewed as a voluntary and collaborative partnership (Cleary et al.2010), such that it supports perceived feelings of ownership. Other research has highlighted how clinical supervision can be viewed as a discussion with more experienced colleagues - that allows for reflection of “clinical experiences in order to recount them and deepen understanding and/or identify areas for further improvement” (Brunero& Stein-Parbury 2008), (also similar to the propositions noted by Wheeler & Richards(2007). In looking at the function of supervision, Milne (2007) suggests the following:

· Quality control (including gatekeeping, and safe, ethical practice);

· Maintaining and facilitating the supervisees’ competence and capability; and

· Helping supervisees’ to work effectively (accepting responsibility, developing own personal identity, enhancing self-awareness and resilience and lifelong learning skills).

In all, the literature outlines that the clinical supervisory process aims to enhance and support best clinical skills for improved outcomes for clients and for addressing cases, contexts and careers.

References

Bland, A. R., Rossen, E. K. (2005). Clinical supervision of nurses working with patients with borderline personality disorder. Issues in Mental Health Nursing, 26(5), 507–517. doi:10.1080/01612840590931957

Brunero, S., & Stein-Parbury, J. (2008). The effectiveness of clinical supervision in nursing: an evidenced based literature review. Australian Journal of Advanced Nursing, 25 (3): 86-94.

Butterworth, T., Bell, L., Jackson, C., Majda, P. (2008) Wicked spell or magic bullet? A review of the clinical supervision literature 2001-2007. Nurse Education Today. 28(3), 264 - 72.

Cleary, M., Horsfall, J., Happell, B. (2010). Establishing clinical supervision in acute mental health inpatient units: acknowledging the challenges. Issues in Mental Health Nursing, 31(8), 525 - 531.

Gonsalvez, C. J., & Milne, D. L. (2010). Clinical supervisor training in Australia: A review of current problems and possible solutions. Australian Psychologist, 45(4), 233–242. doi:10.1080/00050067.2010.512612

Dawson M., Phillips B. and Leggat S (2013) Clinical Supervision for Allied Health Professionals A systermatic Review Journal of Allied Health 42 2 65-73.

Hines-Martin, V., & Robinson, K. (2006). Supervision as professional development for psychiatric mental health nurses. Clinical Nurse Specialist, 20(6), 293–297. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17149020

Milne, D. (2007). An empirical definition of clinical supervision. The British journal of clinical psychology / the British Psychological Society, 46(Pt 4), 437–47. doi:10.1348/014466507X197415

West, B. (2009). Support and Supervision in Nursing: A discourse with the literature. Aberdeen: Hive Design and Consultancy.

Wheeler, S., Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy Research, 7(1), 54–65. doi:10.1080/14733140601185274

Allied Health Professionals

The following table reflects an overview of the literature in respect of Allied Health Professionals which also presents a rationale for executing supervision.

Paper / Rationale for Supervision
Dawson M., Phillips B., Leggat S. (2012) Effective clinical supervision for regional allied health professionals – the supervisee’s perspective Australian Health Review (36) 92-97 / Recognises the importance of clinical supervision to supervisee & within clinical governance
Sellars J.(2004) Learning from contemporary practice: and exploration of clinical supervision in physiotherapy Learning in Health & Social Care 3 (2) 64-82 / Identifies the support required to effectively integrate & sustain clinical supervision.
Fischer M., Mitshe M., Endler P., Mesenholl-Strehler E., Lothaller H & Roth R. (2013) Burnout in physiotherapists: Use of clinical supervision and desire for emotional closeness or distance to clients (2013) International Journal o Therapy and Rehabilitation Vol 20 No 11 550-558 / Regular supervision or support can help reduce the risk of burnout - helping staff to deal better with work stresses
Hall T. and Cox D (2009) Clinical supervision; an appropriate term for physiotherapists? Learning in Health and Social Care 8 4 282-291 / Supervision supports practitioners competence and confidence throughout their career
Kuipers P., Pager S., Bell K., Hall F and Kendall M (2013) Do structured arrangements for multidisciplinary peer group supervision make a difference for allied health professional outcomes? Journal of Multidisciplinary Healthcare 6 391-397 / Supervision can have a positive impact on quality of patient care and help staff cope with job stress
Morley M and Petty N (2010) Developing an observed practice programme for occupational therapists and physiotherapists: reporting the first phase of an action research study British Journal of Occupational Therapy 73 (8) 379-387 / Observed practice as a concept in supervision can assist professional development and improve clinical practice
Ostergren J.A. (2011) The first year of Professional Service in Speech-Language Pathology: supervisory role, working relationships, and satisfaction with supervision Contemporary Issues in Communication Science and Disorders 38 61-75 / Outlines how supervision and supervisors role can support newly qualified staff

The Benefits of Clinical Supervision

A variety of benefits have been identified from the process and outcomes of clinical supervision. Briefly these advantages can be summarised under the headings of personal benefits, patient care benefits and organisational benefits. The benefits under each of these headings will necessarily overlap with each other.

Benefits recognized for the individual in receipt of clinical supervision include a feeling of being supported. This may manifest itself in individuals feeling less isolated and experiencing less stress and burnout (Sloan 2005). On the positive side supervision may also promote increased personal confidence, self-value and enhance job satisfaction (Cotton 2001). Other than providing support, supervision has been identified as a tool for personal development. Similarly Kuipers, Pager, Bell, Hall & Kendall (2013) noted that a formal supervision process in additional to having a positive impact on the quality of care, helped staff cope with the work stress and increased their level of confidence. This development may show itself in a number of ways: increased knowledge and awareness of possible solutions to clinical problems; increased self-awareness; participation in reflective practice (Winstanley and White 2003).

The benefits that individual clinicians derive from supervision should in turn contribute to improved patient care. In this respect Cotton (2001) points to the potential for clinical supervision to improve the quality of patient care through the development of professional practice. Clinicians who had scheduled opportunities to reflect on their clinical practice noted that this “quality time” supported their professional development Sellars (2004) . Equally Chilvers and Ramsey (2009) believe that clinical supervision, by reducing occupational stress, should safeguard the standards of patient care, and therefore improve the overall delivery of the quality of service.

Finally organisations should also benefit from the outcomes of clinical supervision. A feeling of personal well-being may result in less sickness absence (Sloan). Similarly supervision have may an impact on staff turnover and risk management with obvious economic benefits to the organization (Chilvers and Ramsey).Effective clinical supervision is considered an important component of clinical governance – supporting improvements in clinical practice through reflection and support of clinicians (Dawson, Phillips and Leggat (2012).

Interestingly a counterview of the benefits of CS is also presented in the literature. Cleary et al.(2010) posit that existing practices already offer the claimed benefits of clinical supervision and that too much emphasis is being placed on it. They cite Nicklin (1995) who argued that good training, management and pastoral care could achieve similar benefits to that of clinical supervision.

References

Chilvers, R., Ramsey, S. (2009). Implementing a clinical supervision programme for nurses in a hospice setting. International Journal of Palliative Nursing. 15(12), 615 - 619.

Cotton, A. (2001). Clinical supervision UK style: good for nurses and nursing? Contemporary Nurse: A Journal for the Australian Nursing Profession, 11(1), 60 - 70.

Dawson M., Phillips B., Leggat S. (2012) Effective clinical supervision for regional allied health professionals – the supervisee’s perspective Australian Health Review (36) 92-97

Kuipers P., Pager S., Bell K., Hall F and Kendall M (2013) Do structured arrangements for multidisciplinary peer group supervision make a difference for allied health professional outcomes? Journal of Multidisciplinary Healthcare 6 391-397

Nicklin, P. (1995). Super supervision. Nursing Management, 2(5), 24–25.

Sellars J.(2004) Learning from contemporary practice: and exploration of clinical supervision in physiotherapy Learning in Health & Social Care 3 (2) 64-82

Sloan, G., Watson H. (2002) Clinical supervision models for nursing: structure, research and limitations. Nursing Standard, 17(4), 41 - 46.

Sloan, G. (2005). Clinical supervision: beginning the supervisory relationship. British Journal of Nursing, 14(17), 918 - 923.

Winstanley, J., White, E. (2003). Clinical supervision: models, measures and best practice. Nurse Researcher, 10 (4), 7 - 38.

Statutory Supervision of Midwifery Practice

The references below describe some of the benefits around statutory supervision of midwifery Practice:

Brintworth. K., Johnson, G. (2013) Supporting the supervisors Midwives magazine: Issue 4 :: 2013

Kirkham, M. (1998) Evaluation of the Impact of the Supervision of Midwives on Midwifery Practice and the Quality of Care. London. English National Board for Nursing and Midwifery

Rogers, C., Yearley, C. (2013) National survey of supervision of midwives: time for reflection? British Journal of Midwifery 21(5): 356-63.

Shaw, A.M., Clarke, D., Long, A.F. (2013) Midwives and supervisors of midwives’ perceptions of statutory supervision of midwifery within the United Kingdom: a systematic review. Midwifery 29(1): 75-85.