Introduction to Clinical/Professional supervision

Introduction.
This section of the site provides a brief introduction to clinical/professional supervision. It provides a useful information and some foundations from which nurses may begin to think about some of the relevant issues related to clinical/professional.

What is clinical/professional supervision?
Clinical/professional supervision is a broad concept, having been adopted and integrated into many helping professions. Definitions tend to delimit the boundaries, range, role and depth of supervision. As to the content of clinical/professional, this tends to be informed by its area of application as supervision of a specific mode of intervention may encompass some didactic teaching of skills central to that application.

In nursing, clinical/professional definitions tend to encompass aspects of learning, interpersonal support and oversight - however, not all authors agree on this basic summation. It has been acknowledged within the literature the need for a range of models to address the diversity of practice within nursing. Most models do, however, tend to encompass the above dimensions. Differences in emphasis upon each of the elements may be in evidence according to the issue presented, the developmental level of the supervisor and supervisee, their career stage, the model of nursing and supervision used and extraneous factors imposing upon the relationship. For example, a beginning practitioner may need additional oversight and educational input compared to a seasoned practitioner, who may need relatively more interpersonal support.

Supervision models also vary in the emphasis given to each of the above elements, sometimes in accord with the orientation and view of the originating theorist. Models derived by educationalists stress learning, models derived by managers tend to stress oversight, service quality and outcomes and those developed from psychotherapeutic approaches often emphasise interpersonal support.


A Definition of Supervision

There are very many definitions of supervision, the following was disseminated from the NHS Executive in 1993:
“A term used to describe a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations. It is central to the process of learning and to the expansion of the scope of practice and should be seen as a means of encouraging self assessment and analytical and reflective skills.”

Approaches to (modes of) Clinical/Professional Supervision 

• Individual Meeting one to one with a more experienced clinician acting
• Peer Meeting one to one with an equally experienced clinician
• Group (led) Meeting as a group with more experienced clinician acting as supervisor
• Group (peer) Meeting as a group of similar level experience with no designated supervisor or group leader
• Team Meeting as multi-disciplinary clinical team to address clinical issues, either with or without designated supervisor

Strengths and potential challenges of Individual Supervision

Strengths	Potential challenges
More time for supervisee	Full weight of focus on individual supervisee
Opportunity to create clearer and more focused objectives	Input from only one person (supervisor)
Highly personalised	Difficulties if supervisory relationship breaks down
Supervisee can work at own pace	Evaluation and feedback from one person’s perspective only
Non-competitive environment	Can become collusive with little challenge
Allows supervisee to concentrate on one particular issue	Can foster dependency in supervisees
Development in supervision can be easily monitored	Less comparison for supervisees re. other ways of working
Supervisors intentions can be geared specifically towards the learning of the supervisee	Transference issues may hamper task if unresolved

Strengths and potential challenges of Group Supervision

Strengths	Potential challenges
Input from a number of people.	Individuals needs may not be addressed.
Supportive atmosphere from peers.	Individuals may get ‘lost’ or ‘hide’ within the group
Value of listening to others describe their work and problems they face.	There may be a lack of time for group members with large caseloads
Cost effective in time and economics.	Not all are suited to group work
Can allow experimentation with other interventions	Can be used as a “dumping ground”
Can help supervisees deal with issues of dependency on supervisors.	Group dynamics may temporarily block the task
Evaluation and feedback from a number of people.	Pressure to conform, ‘Group think’
Risk taking can be higher in group setting	Difficulty for newcomers to enter group
Emotional support from peers	Some topics may not be of interest to other group members
Issues arising from within the group can be addressed	Lessening of confidentiality
Dilutes power of supervisor	Overload for some members

Clinical/Professional Supervision Interpersonal Skills

In a supervisory relationship, the supervisor may:

• Create a context for curiosity for the supervisee
• Generate multiple perspectives on a situation
• Invite supervisee to arrive at their own solutions
• Give positive feedback
• Confirm persons ability
• Create new perspectives on nurse-client relationships

Clinical/professional supervision is underpinned by an agreement forged by and between the participants. This agreement or ‘contract’ makes explicit the nature and boundaries of the relationship. A session-specific agreement between participants can be negotiated at the beginning of each meeting, which will outline the goal(s) of that session and help clarify the steps needed to achieve them. Time within the sessions themselves may be structured by using models or frameworks for helping understand the pertinent issues and work towards a solution of greater understanding.

Models to structure the supervision space:

Simple Reflective Model (Gibbs amended)
Description
What happened? Telling the story (uninterrupted)
Feeling
What were you thinking and feeling? (How are you feeling now as you retell the story?)
Evaluation
What was good and bad about the experience? (why was it good or bad and what are you basing this judgement upon?)
Analysis
What sense can you make of the situation? Think about what this means to you
Conclusion
What else could you have done? (And the reasons why you didn’t?)
Action plan
If it arose again, what would you do? (the same thing or something different). Is it a situation you expect to deal with again? If not how could your reflections be applied to other situations?


Interpersonal Process Recall (Kagan, Adapted By Stern)
This model is particularly suited to beginning practitioners and to self supervision - the development of the ‘Internal Supervisor’.

• What did you feel?
• What did you think?
• What bodily sensations did you have?
• What did you do or say?
• What would you rather have done or said?
• What would the risks be if you had done/said this?
• What do you imagine this person was thinking/feeling?
• What images, associations, memories does this bring up?
• Anything else?

Please note: The terms Clinical Supervision and Professional Supervision are interchangeable.

Modified by Vicki Yarker-Hitchcock 2004 from “Introduction to clinical/professional” http://www.clinical-supervision.com/

 

Thoughts on clinical/professional supervision

A true friend is another self, they share a single soul. There is a need for shared excellence and implicit understanding”.
Within supervision we take on another’s concerns and pleasures, whilst appreciating our differences. We share a mutual desire for good quality practice and need a shared understanding of the philosophy of clinical governance to which to aspire.

The true friend is a mirror and by observing his virtue I study my own.
Clinical/professional supervision is the container where reflective practice takes place. As the supervisor observes the thoughts and feelings of the supervisee they also are aware of their own practice and how this can be influenced for the good by being with another. We also see ourselves through the eyes of another, which can enlighten us to changes we may have to make and enable us to confront, at times, uncomfortable self knowledge.

True friends make one another good by shaping through interaction. Pride is taken in the good of a friend almost as if it was one’s own product.
Within clinical/professional the relationship is of prime importance and as the supervisor and supervisee progress through the supervisory journey together it is a source of great, shared satisfaction to see the development of the supervisee and supervision across time.

True friends share a history, which leads them to trust their goodness and empathise with their pleasure and pains. There is an investment in the others fate.
All nurses share a common history and an ethical base for practice. Nightingale saw this as preserving the patient’s dignity, and I would add it is also about preserving the nurse’s dignity. The clinical/professional relationship extends over time and develops its own history, shaping those involved and perpetuating the contact. Stories, such as those told within supervision or indeed by clients constitute that history and these are told and retold as is the story of the friendship.


Reference: Georgina Smith 2001 (for 4 above quotes).