Fundamental Themes in Clinical Supervision

Tony Butterworth, John R. Cutcliffe, Brigid Proctor

• Publisher: Routledge
• Year: 2005
• ISBN:
  9781134584604
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Clinical supervision has been available to nurses for over a decade. This book, edited by leading practitioners in the field, looks at how clinical supervision has developed during this period and what the issues are for the future, including:
* education and training in clinical supervision
* the introduction of clinical supervision into policy and practice
* the practice of clinical supervision within the different nurse specialisms
* current research activity
* international perspectives and experiences.
The book is firmly grounded in clinical practice and all the contributors write from real experience. They include clinicians, educationalists, researchers and policy makers from the UK, Finland, America and Australia.
Containing the latest research evidence, Fundamental Themes in Clinical Supervision demonstrates the potential of this form of training to support staff and improve client care an essential tool for nurses and other health professionals.

1 Introduction

Fundamental themes in clinical supervision: national and international perspectives of education, policy, research and practice

John R. Cutcliffe, Tony Butterworth and Brigid Proctor

Why another clinical supervision book?

Examination of the relevant healthcare literature will show that there is a growing number of books that focus on clinical supervision. Indeed, each of the editors has contributed significantly to this growing body of literature, having written a number of academic and professional papers, in addition to books on clinical supervision. So the reader could be forgiven for asking; why another book?

Our experience (and many of the findings in the research studies detailed in this book) suggest that when people have had some experience of clinical supervision, they appreciate it, understand it, become aware of its application and worth, and want it. Consequently, rather than a book that is based on theoretical perspectives, this book is comprised of a collection of chapters from authors who are involved in practice relating to supervision. Each of them has experienced supervision and it has left a lasting impression. Those chapters on education have been written by authors who provide training (and receive supervision) themselves. Furthermore, those that discuss attempts to introduce/implement it have experience of these very endeavours: each of the research chapters is written by authors who have carried out the research. Given the variety in the nature of the chapters, some have a more academic sense or flavour than others.

In addition to this, an examination of the relevant empirical literature highlighted certain gaps in the knowledge of the substantive area of clinical supervision. The editors noted gaps in the particular areas of:

• literature that examines and brings together national and international perspectives of clinical supervision;
• literature that encapsulates the current research endeavours in clinical supervision, highlights current key research questions and summarises the current findings;
• literature that provides experiential evidence from the various specialities/disciplines of nursing that illustrates the process, value and application of supervision in their clinical practice.

The structure of the book

The book was designed in order to address the question: given that clinical supervision has been available to nurses for over a decade, where are we now with regard to the education/training in supervision, the introduction/policy of supervision, and the practice/research of supervision from both a national and international perspective? Hence the book has the following structure:

Part 1 of the text is concerned with current education and training for clinical supervision. Consequently, chapter 2 focuses on the background of clinical supervision in Northern Ireland and provides an overview of the education developments in clinical supervision courses. Chapter 3 examines the ‘how and the why’ of Brigid Proctor’s supervision alliance model, and looks at some of the open learning methods of training in clinical supervision. Chapter 4 concentrates on training practitioners to become competent supervisees rather than supervisors, and suggests a possible structure for such training. Chapter 5 features the development and delivery of a diploma level clinical supervision training course at the University of Nottingham. Chapter 6 concludes this section by describing the development and delivery of a diploma level clinical supervision module at the University of Swansea.

Part II of the text is concerned with the introduction or implementation of clinical supervision into practice. Therefore, chapter 7 outlines how a group of lead professionals facilitated the widespread implementation and development of clinical supervision within a NHS Community Trust. Chapter 8 reports on the experiences of a former clinical supervision co-ordinator and her attempts to implement clinical supervision within a medium sized NHS Trust. Chapter 9 provides a summary of the literature review of clinical supervision, commissioned by the UKCC, and reiterates the UKCC’s current position on clinical supervision. Chapter 10 concludes this section by focusing on attempts to introduce clinical supervision within a large NHS acute Trust.

Part III of the text is concerned with the actual practice of clinical supervision within the different nurse specialisms or disciplines, and with the current research activity into clinical supervision within Britain. Consequently, Chapter 11 leads with a focus on the experiences of a Community Mental Health nurse. Chapter 12 looks at supervision for nurses in the private sector and working within gerontological nursing. Chapter 13 considers clinical supervision for nurse educationalists and sets this practice within the context of a postgraduate mental health nursing course. Chapter 14 explores the practice of cross discipline group supervision, in this instance examining the experiences of Registered General Nurses who were new to the role of clinical supervisor. Chapter 15 focuses on the methods that are being developed to evaluate clinical supervision and highlights the latest attempts to evaluate supervision using the Manchester University Clinical Supervision scale. Chapter 16 considers the argument and evidence for using case studies to provide the qualitative data needed to evaluate supervision. Three case studies are provided in addition to a critique of the use of case studies. Chapter 17 concludes this section by reporting on the findings from a qualitative study that used multi-disciplinary groups to evaluate the experience of receiving clinical supervision.

Part IV of the text is concerned with presenting the international perspective on, and experiences of, clinical supervision. Therefore, Chapter 18 focuses on the Australian perspectives of clinical supervision. Chapter 19 provides a Scandinavian perspective in that it highlights the development of clinical supervision training and practice in Finland. Chapter 20 concludes this section by providing the North American perspectives of supervision. The book concludes by considering: where do we go from here? Consequently, Chapter 21 draws attention to the links between clinical supervision and clinical governance, points out that new ways of working (e.g. NHS direct) demand new models of clinical supervision and considers the future of clinical supervision.

Wherever findings and thinking are considered of fundamental importance to the ideology and practice of clinical supervision, these key statements have been emphasised in bold type.

The editors’ position on clinical supervision

We would suggest that there is no one single correct way to carry out supervision. Any activity is based on certain implicit or explicit assumptions. Rather than give yet another definition of clinical supervision, we want to spell out some of those assumptions, of what we think it is or is not in our considered opinion. The contributors to this book are all talking about the kind of supervision that fits within these parameters. In no particular order of priority, the editors posit that these parameters indicate clinical supervision is necessarily:

• supportive;
• safe, because of clear, negotiated agreements by all parties with regard to the extent and limits of confidentiality;
• centred on developing best practice for service users;
• brave, because practitioners are encouraged to talk about the realities of their practice;
• a chance to talk about difficult areas of work in an environment where the person attempts to understand;
• an opportunity to ventilate emotion without comeback;
• the opportunity to deal with material and issues that practitioners may have been carrying for many years (the chance to talk about issues which cannot easily be talked about elsewhere and which may have been previously unexplored);
• not to be confused with or amalgamated with managerial supervision;
• not to be confused with or amalgamated with personal therapy/counselling;
• regular;
• protected time;
• offered equally to all practitioners;
• involve a committed relationship (from both parties);
• separate and distinct from preceptorship or mentorship;
• a facilitative relationship;
• challenging;
• an invitation to be self-monitoring and self-accountable;
• at times hard work and at others enjoyable;
• involves learning to be reflective and becoming a reflective practitioner;
• an activity that continues throughout one’s working life.

We would argue that, ultimately, clinical supervision has to be concerned with benefiting service users. The truth of the matter is that we are all potential clients or users of health care. Additionally, each of us has, in some way, paid for such care and it is entirely understandable that when we are to be recipients of health care, we would all want the best care possible for ourselves and our significant others. We posit that this ‘best care possible’ can only be delivered by the front line staff, who are competent enough and healthy enough. We believe that engaging in clinical supervision has the potential to encourage precisely that. It can help keep practitioners competent and healthy enough to provide this best care possible. Unless clinical supervision ultimately does have an influence on the care provided, it ceases to be what it was designed to be and becomes something of a rather narcissistic, self-absorbed activity for staff.

There is an increasing requirement for staff who are engaged in helping relationships within health care to be accountable for their actions. However, the mechanisms for encouraging, nurturing and monitoring this accountability are vague. At the same time there is an ongoing requirement for such individuals to re-register as competent practitioners. Inextricably linked with one’s eligibility for re-registration is the need to demonstrate a commitment to continuous and ongoing professional development and, at the same time, a degree of individual accountability. In order to operate as a autonomous practitioner, one first needs to be accountable to oneself and then accountable to another. It is the belief of the editors (and the authors in this book) that clinical supervision provides one mechanism whereby these processes can be achieved.

What should you gain from this book?

Having identified that this book offers the reader something different from other books on clinical supervision, the reader ought to gain something different from reading it. So what should the reader be able to gain as a result of reading this book? Perhaps you should first ask yourself: what do I want to know about supervision?

Then, if you are interested in becoming a supervisor (or supervisee), you should turn to the ‘Education’ section and there you will discover what type of training/education is available, what options you can pursue and at what academic level.

If you are interested in implementing supervision in practice, you should examine the ‘Introduction’ section and can then see some options of the ways this can be brought about, and identify some of the hurdles to the introduction of supervision.

If you are interested in the practice of supervision, you should look to the ‘Practice’ section and become aware of what practice is occurring, how practitioners are experiencing supervision and how it might be of benefit to them.

If you are interested in research, then you should examine the ‘Research’ section and can then determine what are the next logical questions to be asked in supervision, where the current knowledge base is and where future research should be focused.

It is the editors’ opinion that this book identifies the real benefits of receiving supervision and this evidence has been obtained from ‘real’ experiences. The evidence has been provided by practitioners who share the difficulties, constraints and dilemmas that many hard pressed and busy health care practitioners experience. The writing does not come from a collection of academics, who live in a world far from the realities of clinical practice. As a result, the editors view this book as a ‘carrot’ book, rather than another ‘stick’ book. It provides readers with some hope, something to encourage them, rather than adding to the already stifling load of ‘shoulds and oughts’ that practitioners bear. It demonstrates, as a result of the international chapters, how different countries interpret clinical supervision within their national context. It is interesting and illuminating to see different perspectives and such perspectives might make British practitioners think about supervision in a different way. It shows that in the substantive area of clinical supervision, Britain is influential, we have something to teach other countries and something we can learn from other countries. Finally, it sets clinical supervision in context within nursing, and reflects that whilst supervision may have been available for ten years, its potential to support staff, to help them become more individually accountable, and to improve client care has not yet been fully realised.

To borrow an expression that arises from contemporary parlance: we have come far, but there is still a long way to go.

Part I

2 Clinical supervision

Personal and professional development or the nursing novelty of the 1990s?

Billy Kelly, Ann Long and Hugh McKenna

Editorial

This chapter includes an exploration of the background to the development of clinical supervision in nursing, and reviews the body of scholarly work that has been written on clinical supervision. It then offers the Northern Ireland perspective on the practice and training of, and research into, supervision, paying particular attention to the degree module course in clinical supervision provided by the University of Ulster. Lastly, the chapter includes research findings which indicate how valuable practitioners in Northern Ireland find clinical supervision.

We believe that this chapter highlights a key issue, and that is the problems that can occur when clinical supervision is not maintained as a distinct and separate practice to managerial supervision. It is interesting to note that this is a theme (and research finding) which recurs throughout the book. Both practices are legitimate and valuable, however, the overlap of boundaries leads to confusion regarding power issues in supervision. Concerns regarding confidentiality may inappropriately emphasise the normative aspects of supervision, and focus on the needs of the organisation rather than the individual. Therefore, we would suggest that the practices of clinical and managerial supervision remain separate yet complementary to one another.

Introduction

Since the early 1990s clinical supervision has been debated by nurse academics and practitioners, and they have argued for its adoption throughout the United Kingdom (Bishop, 1998a; Crowe and Wilkes, 1998). Simms (1993) reported a growing awareness of, and commitment to, the value of supervision and the supervisory relationship. However, she also referred to the dearth of published research on the subject. While serious consideration has been given to the theoretical aspects and relevance to practice of clinical supervision, (Butterworth and Faugier, 1992; Faugier and Butterworth, 1994; Kohner, 1994), according to Faugier (1996), prior to 1996, little of any substance had been published on the topic in the nursing literature.

Hill (1989), in a review of the literature on supervision in the caring professions, indicated surprise that supervision had not gained greater ground in nursing. Since then, interest has been stimulated by the activities of other professions, where parallels in practice have been demonstrated (Bond and Holland, 1998). These professions include psychotherapy, social work and midwifery (where there is a form of statutory supervision). In addition, community workers are dependent increasingly on forms of supervision directly related to child protection. According to White (1990), mental health nursing adopted clinical supervision based on its close relationship with the therapies and counselling.

However, given the need to tailor supervision to the specific requirements of nursing, caution was urged when adopting approaches to supervision favoured by other disciplines. Faugier (1992) warns against embracing approaches where the therapeutic interventions involved in the supervisory interaction may be inappropriate. Moreover, midwifery and child protection models of supervision are highly managerial in character and may not be an appropriate template for nursing. This is especially so given the emphasis on personal and professional development as important components of clinical supervision.

This chapter is designed to explore the background to the development of clinical supervision in nursing. It begins with a critical examination of evidence presented in the literature with particular reference to the issue of definition and models of clinical supervision. Given the focal point of the book, it continues by emphasising the available research literature on clinical supervision, particularly within the context of mental health nursing. The chapter concludes with a synopsis of a research project that was recently carried out in Northern Ireland (Kelly et al., 2000).

Background and context

The conceptualisation and subsequent implementation of clinical supervision have taken place alongside the reorganisation and revitalisation of nursing’s education system. Having moved away from a task to a process-oriented approach to the delivery of nursing care, the nursing profession committed itself to an expanded and extended role for its members. The introduction of the Code of Professional Conduct (UKCC, 1984) emphasised the importance of professional accountability. Since then, government policy on the management of the health service has been influential in changing the focus of nursing practice and education, and the nurse’s role has altered to include practices that were once the remit of junior doctors (UKCC, 1992).

Within a period of radical education reforms, prominence was given to concepts such as mentorship, preceptorship and clinical supervision (Butterworth and Faugier, 1992; DoH, 1993). These concepts aimed to stimulate and forge new relationships amongst registered ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Figures
• Tables
• Editors
• Contributors
• Acknowledgements
• Foreword
• 1 Introduction
• Part I
• Part II
• Part III
• Part IV