CLINICAL SUPERVISION

1. CLINICAL SUPERVISION Murtada Chaaban Head nurse Hemodialysis units KFSH&RC Riyadh chaabankfshrc.edu.sa

2. Objectives Understand the Clinical Supervision (CS). Identify the benefit of CS. comprehend the aim of CS. Relate the CS to the concept of learning. Recognize different models of CS . Differentiate between CS and management. Identify the characteristic of Clinical supervisor Recognize the component of CS contract.

3. Introduction CS is highlighted item on nursing agenda since (1980) CS has been described as a formal arrangement that bring nurses to discuss their practice regularly with another experienced professional. CS is an interpersonal process whereby a skilled practitioner helps a less skilled or experienced practitioner to achieve professional abilities appropriate to their role, (Barber &Norman, 1987)

4. Definition CS is a formal process of professional support and learning which enables practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and the safety of care�its central to the process of learning� encourage self assessment, analytical and reflective skills. (NHS, 1993 ). CS brings practitioners and skilled supervisor together to reflect on practice. Supervision aims to identify solution to problems, improve practice and increase understanding of professional issues. (UKCC position statement,1996).

5. CS aims CS is a formal support system that aim : Steered reflection in practice. Provide support to avoid mistake recurrence Create an environment where good practice can challenged, developed, and improved, Enhance positive and healthy working environment.

6. Components of CS CS require three main components: Infrastructure; the administrative foundation that allows work based learning Relevant experience which provide opportunity to enhance individual skills through exposure to learning opportunity. Learning culture; the value that the organization and people within place engaging learning for growth and development.

7. Function of CS There are three main function of CS (Proctor 1986). Formative; is the educative process of developing the skills, understanding and abilities of practitioners. Restorative; is about supporting the practitioner to adopt their copping skills, in relation to the varying levels of stress within the clinical setting. Normative; is where the practitioner looks at the quality of his work and how this fits within the standards.

8. Potential benefits of CS Personnel development/growth . Identify learning needs. Improve working relationship. Enhance reflection on practice. Opportunity to receive positive feedback. Provide link between research and practice (Identify research subject). Provide emotional support for the practitioner (far from the managements).

9. Potential benefits of CS Individual recognition of a sense of personnel worth and the sense of being valued. More effective use of skills, knowledge and expertise. Develops innovative practice Better quality of care for the clients. Acknowledgment of stress and difficult workloads.

10. Potential benefits of CS Improves patient/ client satisfaction. Contributes to risk management and decrease adverse occurrence incidents Increase staff satisfactions and by consequence staff retention. Maintain and safeguards standards. Improve qualities of care. Protect the patients receiving care from the nurses and protect nurses (Barker 1992).

11. Factors affecting CS The implementation of CS is affected by two main factors that influence its presence for nursing/ health professions: 1) External factors. 2) Internal factors.

12. Why CS IS Needed ? External influences summarized: Presence of patient�s Charter leading to increased expectation from the public (DOH 1992). Increased awareness of a growing need to manage risk in modern health service (Tingle, 1995). Dynamic changes within current health system (darley,1995). Recent innovation in the medical management and treatment of patients (Kohner, 1994)

13. Why CS IS Needed ? Internal professional influences can be summarized: Professional regulatory body and it role that: Is entrusted to protect the interest of the public. (code of conduct) Stat the professional requirements for education and practice. (license) Development of professional accountability. (code of conduct) Introduction of the scope of professional practice.

14. Why CS IS Needed ? Emphasis on the continuous professional development (LLL). Accelerating organizational change (Palsson et al, 1994) Complex health needs (DOH, 1992). Demand for research and evidence base practice. (Bats tone & Edward, 1997) Movement of nursing from task oriented towards more individualized approach (Rogerson et al, 1993)

15. Why CS IS Needed ? Increase development of independent practitioner roles (Dolan et al, 1997) Integration of nursing education into institutions of higher education (Fish and Twin, 1997). Development of multi-professional partnerships (including patients). Increase usage of clinical audit & QA and customer feed back. Response to increase workload

16. Is Professional Support Necessary for Nursing? The nursing profession has continually acknowledge the value of developing professional support system (Casement, 1992; Smith 1992) The need for organized support system is well expressed in the literatures, ( Firth &McIntee1984). Despite that recognition, Nursing profession has tended to neglect the idea of professional support and view occupational pressure as for the individual to deal with. (Hingley & Harris 1986; Bowman 1995)

17. What Elements Constitute a Support System (SS)? In each organization there are always some sort of SS, that can be classified in two types: Formal SS: mentorship, Preceptorship, Performance appraisal, Education program, Research projects, Clinical supervision, �. Informal SS: Team nursing, Staff meeting, Morning report, Peer relationships, Journals, books, Internet facilities, ward project, Symposium etc�

18. Common Roles of the SS Offer individual and professional development. Encourage and motivate staff. Enable identification of the learning needs. Facilitate learning. Offer emotional support.

19. Uniqueness of CS Authors see Preceptorship, Mentorship and Clinical Supervision as a continuum rather than substitute for each other (Holland &Band 1997). The specific characteristics of Clinical Supervision are: CS is formulated mainly for the clinical senior nurses. Facilitate the learning in clinical environment.

20. Uniqueness of CS Enhancement of standards of care through ensuring that practice is safe and evidence based. Enabling role development and innovation. Offering clinical leadership. Promoting reflective practice and the development of critical thinking skills.

21. Uniqueness of CS The process of CS should be developed by managers and practitioners according to the local circumstances. Ground roles should be agreed, at the beginning; written contract include the purpose of the CS session, confidentiality disclosure, consent, if CS included in the employment contract document can be requested by the mangers, otherwise not allowed!

22. Uniqueness of CS Every employee should have access to CS. (once/year). Each supervisor should supervise a realistic number of practitioners. Preparation of supervisors is crucial for the CS success. Evaluation of CS is needed to assess its influence on the practice.

23. Uniqueness of CS Clinical supervision is not: Managerial control system. The exercise of overt managerial responsibility. Formal performance assessment. Disciplinary action. Personal counseling. Hierarchical in nature.

24. Approaches to CS CS can be carried out in many ways and with different people. (Houston 1990; Barton-Wright 1994; Faugier &Butterworth). Self Supervision where the individual is able to reflect upon his/her work. Team supervision; among a group of colleagues who work together (Primary nurse team). Network supervision; among people who do not work together (community nurses)

25. Approaches to CS Group Supervision; between a group of colleagues who have a common link ( Preceptors). One-to-one Sessions which I believe is the most effective approache: Expert supervisor from the same discipline ( senior/Junior). Expert supervisor from different discipline ( IV nurse). Peer supervision; colleague of a similar expertise and grade, (may be lower).

26. Clinical Supervisor Clinical supervisor play essential role in the success of CS. The preparation of Clinical supervisors is crucial, relevant practice, experience is important as well as the development of the necessary skills, qualities and characteristics to achieve the required outcomes.

27. Clinical Supervisor Qualities and characteristics of a good clinical supervisor (Piemme et al 1986; Fowler 1995; Mahood et al 1998): Knowledgeable on the supervisor roles, supervisees role, supervision models. clinical credible Skills: teaching (adult learning) assess knowledge and experience, communication, interpersonal, reflection (can be reflective and facilitate discussion and reflection).

28. Clinical Supervisor Objective clinician, open mindedness, non-judgmental, non abusive, non-threatening, Genuine, self-aware, self-confidence assertive, organized Approachable, flexible, empathetic. patience, have sense of humor. Advisor, coacher, sponsor, counselor Resource facilitator. Role model.

29. Models of CS There are several models of CS: Interactive/Functional model based on: (Proctor 1991) Normative tasks that help people to develop standards. Formative tasks that help people to develop skills. Restorative tasks help to validate each other and develop a climate of safety (Useful to initiate CS).

30. Models of CS Integrative or Process model: the focus in this model is on the process of the tripartite relationship during the supervisory session; (supervisor supervisee & the patient in addition to work context), tasks and functions are made explicit. This model most useful when the primary work of the nurse is the use of self reflection on the nurse/client relationship. (Hawkins and Shohet 1993).

31. Models of CS Relationship or Growth and support model: the focus on the nature of supervisory relationship and how the development of the supervisee affect this relation. Also it provides guidance to the supervisee and the supervisor roles (Generosity, humanity, rewarding; openness, willing to learn, thoughtful etc�) (Faugier 1992)

32. Factors affecting CS Knowledge of the concept of CS Commitment to the philosophy and process of CS. Space and time is needed for CS to take place effectively. Confidentiality is essential to build trust relationship. Previous experience of CS both good and bad.

33. Factors affecting CS Organizational blocks, senior managers play a crucial role on the implementation of CS. Maintaining the boundaries without influencing the other work relation. Personal ability to learn and to deal with criticism. And to provide positive criticism. Accountability; clinical supervisor is not responsible for the action of the supervisee.

34. Components of CS Contract In addition to the biographic data it is recommended that the CS contract should include five stage: Stage I: What are the expectation of each person entering in the supervisory relationship? What are the goals of the CS session? What benefit do you want from CS? Which model would be used?

35. Components of CS Contract Stage II: When the sessions will begin, and how often? For how long each session will be? Do we need to keep record? If yes For what and which method of record is going to be used?

36. Components of CS Contract Stage III: What will happen if professional standards are compromised? e.g. Unacceptable professional conduct, or unsafe illegal practice, circumstances where confidentiality may have to be disclosed and how this will be achieved.

37. Components of CS Contract Stage IV: How the sessions will be structured? What tools will be used? (for daily learning) How to ensure continuous focusing on CS within each CS session? What issues are not appropriate for CS?

38. Components of CS Contract Stage V: When the contract will be revised? What circumstances necessitate the contract to be reviewed? (change of post). If Clinical supervision included in the employment contract, employer can have access to the supervision documentation without supervisee consent.

39. Conclusion I would like to ask you answer: Do you think we need to have Clinical supervisor ? If No what is the alterative? If yes, what you are going to do to implemented?

40. Thank you Murtada Chaaban Head Nurse KFSHRC Riyadh chaaban@kfshrc.edu.sa

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