Personal & Professional Development Module

1. Personal & Professional Development Module Clinical Supervision - Past, Present & Future? Sam Samociuk

2. Agenda for the Lecture • Rationale • Context • Functions • Defining Clinical Supervision • Types of Supervision • Structures for Supervision • Models of Supervision

3. Rationale and Context for Clinical Supervision

4. Support Roles in Nursing Pre-Registration • Assessor - Supervisor (Mentor) • Field Work Teachers • Liaison Teacher Post-Registration • Preceptor • Clinical Supervisor • Line Manager

5. Functions of Support Roles Pre-Registration • The emphasis is on Assessment of Competencies, through observation of the students demonstration of the appropriate Knowledge, Skills and Attitudes required to be a qualified Nurse.

6. Support Roles (2) Post-Registration • The emphasis is on developing one’s capabilities, with a deeper understanding of the practice of nursing through a reflective exploration of one’s work

7. COMPETENCE • Competence is, “possession of the Knowledge, Skills and Attitudes enabling an individual to perform fully in a basic professional role.” (CPSM 1979) • Competencies are individual, measurable skills, demonstrated and assessed against agreed standards of competence.

8. CAPABILITY • is an all-round human quality, an integration of knowledge, skills and personal qualities - used effectively and appropriately in response to varied, familiar and unfamiliar circumstances. Capability is demonstrated through - • judgements • dialogue and exploration • deep rather than surface learning

9. Why is Supervision topical now? • A desire to support ‘Innovation’ in practice • A desire to create a culture of ongoing professional development forall • A wish to acknowledge the stress of caring and to avoid ‘burn-out’

10. Why is Supervision topical now?(2) • A belief that public safety is more at risk • A belief that practitioners are more accountable • A belief that practitioners want to expand their roles and practice • A desire to create ‘reflective practitioners’

11. The Reality of Nursing Practitioners encounter, • “very individual, complex, messy and indeterminate situations, demanding an individual and innovative approach.” Powell, J. (1991) • “Practitioners are frequently embroiled in conflicts of values, goals, purposes and interests.” Schon, D. (1991)

12. The Stress of Nursing • “Nurses ‘burn-out’ because they work in a toxic environment” This toxin is the, • “ pressure that is put on you by the external organisational forces that determine the conditions under which you work” • “ the prime candidate for burn-out is the nurse who strives for excellence in a toxic environment.” Cullen (1995)

13. The Functions and Territory of Supervision

14. The Functions of SupervisionProctor, B. (1986) • Normative - establish maintain & monitor standards & competencies • Formative -educationalaspects of practice development • Restorative - practitioner’s emotional & psychological well-being

15. The Territory of Supervision (Hawkins 1982) Organisation c Client d ab Practitioner

16. Types of Supervision • Professional / Personal Supervision - all three areas of the territory are given equal attention, akin to Mentoring. • Clinical Supervision -the focus is on the practitioner’s direct patient/client contact

17. MANAGERIAL Offered by a line-manager Direct responsibility for your client group Direct responsibility for the team Direct responsibility for you in the Organisation CONSULTATIVE Offered by someone external to the practitioner’s clinical team Indirect responsibility for your client group Indirect responsibility to your team Forms of Clinical Supervision

18. Defining Clinical Supervision

19. What is Clinical Supervision? • It is primarily concerned with the practitioners direct patient/client care • It is a formal undertaking, and hence needs to have an interpersonal contract established at the outset • It is a skilled activity for which both parties should be prepared

20. What is Clinical Supervision? (2) • It is a process of exploration and reflection which aids personal and professional development • It is bound by the practitioners’ professional code of ethics and conduct • It is intrinsically interwoven with practice • It is necessary for all practitioners irrespective of experience, and qualifications

21. Defining Clinical Supervision “Clinical Supervision is an interactive process between providers of health care, which enables the development of professional knowledge and skills.” Butterworth and Faugier (1993)

22. Definition (2) “Clinical Supervision is a formal, ongoing, collaborative relationship, whereby one person ( the supervisor), assists the other ( the supervisee) to attend to issues of clinical effectiveness and professional well-being, with the underlying intention of enhancing the quality of client/patient care.” Lawton D (1995)

23. The Aims of Clinical Supervision(Barker P in Butterworth & Faugier 1994) • To protect people in care from Nurses • To protect Nurses from themselves

24. Establishing Systems for Clinical Supervision

25. Rights & Responsibilities of Supervisees (Bond & Holland 1998) • Informed Choice of who your supervisor is • To receive supervision from someone who is not your line manager, or team leader • To talk about what you want to talk about • To be treated with respect as an equal partner in the relationship • To protected time and space for the sessions

26. Rights & Responsibilities of Supervisees (2) • To have cover so not ‘on-call’or interrupted • To talk about difficulties and vulnerable feelings without being criticised • To be able to celebrate successes • To take part and fully utilise the opportunity • To be open to learning and change • To be responsible for the outcomes of your supervision and subsequent actions

27. Responsibilities of Supervisors • establish a safe environment • explore and clarify thinking • give clear feedback • share information, experience and skills • confront personal and professional blocks • be aware of organisational contracts Butterworth (1995)

28. Establishing Supervision “It does not fit easily into a diary full of shifts, appointments, meetings, courses and holidays.” (Farrington 1995) “Supervision (on busy wards) is often the first activity to be relinquished and the last to be reinstated.” (Thomas and Reid 1995)

29. Establishing Supervision (2) “Clinical supervision should not make demands on nurses’ personal commitment or time. There is a need to integrate clinical supervision as an operational necessity at policy level and to ensure that staff are released for supervisory sessions.” Kohner (1995)

30. What are the optional methods? • One-to-one sessions with Supervisor from the same discipline and team (Nursing,Psychology,Social Work,O/T) • One-to-one with someone from a different discipline, in/out of same team • Peer Supervision, may be 1:1, Triads, or Group • Group Supervision with an ‘outside’ or ‘inside’ facilitator

31. PROS Variety of views Broad support Insights gained = team impact Low cost Shares input Facilitated by Peers CONS Overwhelming Rescuing Focus lost to team support issues Undervalued Lacks depth Conflict of needs and interests Structures for Clinical Supervision: Groups

32. Models of Clinical Supervision

33. Cyclical Model of Clinical Supervision

34. (Page & Wosket 1994) • Contract • Focus • Space • Bridge • Review

35. Supervision - a Working Alliance “The working alliance is a collaboration for change” 3 main aspects :- • Mutual agreements and understandings regarding the Goals of the supervision • The tasks of each of the partners • The bonds necessary to sustain the enterprise

36. Supervision Contracts Expectations of each other regarding; • The Type and Form of Supervision (P/P, or Clinical - M, C, E) • Boundaries of Confidentiality • Methods/requirements for bringing material to work on • Frequency,Duration,Venue • Provision for non-attendance, sickness, holidays etc

37. Contracts (2) • Fees, when applicable • Mechanism to evaluate and review the arrangement • Employing Organisation requirements (audit, record of contact, reports) • Course requirements, where supervision is stipulated All may be reviewed in context of specific professions needs (BAC, ENB,CETSW)

38. Process Model of SupervisionHawkins & Shohet (1989) Supervisor Nurse Patient/Client

39. How to Use Clinical Supervision Effectively

40. Ways of taking practice issues to Supervision Written prompts/ accounts e.g • Log, Diary Journal work • Practice Profiles • Gibbs Cycle • Critical Incident Analysis • Johns Structured Reflection • Case Presentations

41. Ways of taking material to Supervision (2) • Verbal accounts of clinical work and related issues • Audio/Video tapes • Process recordings • ‘Live’ Supervision (2-way mirrors)

42. A Process Model of Supervision (Hawkins/ Shohet) • Mode One :-Focuses the supervisee on Who the patient/client is, and What they are bringing to work on. • Mode Two :-Focuses the supervisee on the actual skills, strategies and interventions they have used- and reviews/explores effectiveness and options.

43. Process Model (2) • Mode Three :- Focuses the supervisee on their relationship with the patient/client, how this is characterised, and the dynamics and issues affecting the work • Mode Four :- Focuses the supervisee on what they feel and experience as a result of working with their clients

44. Process Model (3) • Mode Five :-Focuses the supervisee on what is happening in the supervision session, as a window into the parallel processes in their clinical work. • Mode Six :- The Supervisor focuses on their own experience of the supervision material shared, and offers their responses, images or metaphors.

45. The Benefits of Clinical Supervision • The practitioner feels valued and supportively ‘held’ • Enhances the practitioners ability to make therapeutic relationships and take risks • Broadens awareness of self, knowledge, aesthetics, skills, ethics and wider issues. • Enhances quality of patient care • Promotes maintenance of professional development

46. A Vision for the Future? “ clinical supervision is 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.”

47. A Vision for the Future? “ 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.” A Vision for the Future (1993)

48. Evaluation of clinical supervision • UKCC Key Statement Six “ Evaluation is needed to assess how it influences care, practice standards and service. Evaluation systems should be determined locally.” UKCC (April 1996)