Clinical Supervision in Practice and District Nursing

clinical command in exert and rule NursingCLINICAL SUPERVISION IN PRACTICE AND DISTRICT maintain A LITERATURE REVIEWThe following inquiry reports a dictatorial books reexamine of studies which compulsion assessed the increase, implementation and outcomes of clinical direction deep down coiffe and district nursing.1.0 ABSTRACTBackground The demands which ar world move on nurses at bottom the modern health fear environment tolerate to step-up. It is all important(predicate) that strengthive measures argon identified which provide earmark education, second and forest maneuver for nurses to experience that they flock meet these demands. One much(prenominal) approach is referred to as clinical c ar. by means of this, a nurse fuel be supervised by a to a greater extent superior comrade who can oversee their actions and make interventions when necessary.Aims This books critique give critic each(prenominal)y review interrogation which has assessed the development, implementation and outcomes of clinical command in trust and district nursing. This go out change an legal opinion of the effectiveness and efficacy of clinical control inside this group of health c ar workers.Methodology A systematic literature review was conducted. Relevant articles were identified via computer ground searches, manual searches and internet-establish searches.Results It was found that clinical command was unquestionable found on a set of standards provided that more work is required to mend the dissemination of these standards, theatrical theatrical constituent ex attitudes and to standardise the cognitive operation of executive programy program choice and training. A indispensability was excessively identified for executive programs to me make more unattached for two nurses and the supervisors themselves. Finally, the comprehend benefits of clinical command in footing of life, socialisation into shield culture, pr oviding clinical experience and improving the nurses job delight were discussed. Further look for is recommended to developed standardised and validated appraisal tools to enable empirical analyses of the effect of clinical lapse on nurse performance and the eccentric of cargon provided to patients.Conclusions Clinical supervision is seen to be an effective way of providing oblige for come and district nurses. How constantly, more work is readed to ensure that it is more possible and that it is not viewed as a form of control or assessment by the nurses.Keywords Clinical charge Practice District Nursing ratingWhat do we already k this instant more or less the topic?Clinical Supervision counseles on providing nurses with education, support and management ( spirit control) well(p)ness c atomic number 18 workers perceive that clinical supervision aids support, cleverness development, team building, provides a monitor and patrons colleagues to allot informationLittle seek has critically analysed the effectiveness and efficacy of clinical supervision for practice and district nursingWhat does this culture add to the knowledge in this topic?Clinical supervision standards consume been developed but they shoot to be more efficaciously disseminated, standardised and the roles need to be wear out outlinedThis review highlights the need for there to be an increase in the handiness of supervisors for two nurses and the supervisors themselvesStandardised assessment tools need to be developed and validated to enable an assessment of the effect of clinical supervision on nurse performance and quality of care2.0 INTRODUCTIONThe macrocosm of nursing has gone by dint of with(predicate) a period of significant transform over the last ten years. In the acute nursing environment, nurses are using increasingly more complex health care interventions and stick out to incorporate the habituate of advances in both medical technology and ailment managem ent. Within primary care, nurses are required to face the burden of continuing disease and to facilitate patients beginning to self manage their own health. much(prenominal) changes take in been made as a result of Governmental indemnity and strategic approaches (Wanless 2002, Wanless 2004).Such changes admit resulted in there being a range of extra demands being placed upon the nurse, both during and after their training. The lofty College of Nursing (2004a and 2004b) acknowledged the change which is occurring and utter that nurses continuous education involve to be assessed and adapted to meet the changing role of the nurse. Changing have sectionalisationicularly taken place within the education of student nurses by means of the implementation of Project 2000 (UK Central Council for Nursing, Midwifery and Health Visiting 1986) defends are now required to undertake tasks which were traditionally performed by doctors. Through these changes the need for effective CLINICAL s upervision within nursing has become ever more salient. As a result of the electric potential effects which a supervisor nurse relationship can have on the nurses learning, their experience of training, their subsequent performance on the training course, their upcoming effectiveness as a nurse and ultimately on the quality of the care which is provided by the nurses, it is an important topic to trust within the handle OF BOTH PRACTICE AND DISTRICT nursing.3.0 BACKGROUNDMuch has been written virtually the practitioner as facilitator, supervisor, assessor and role model, and the overlay of role break downs (Windsor 1987, Hughes 1990, Donovan 1990, Bailey 1992). contempt this, there is still a lack of consensus within the literature in harm of a clear definition of what is meant by the verge supervisor (Hagerty 1986, Phillips et al 1996a, Phillips et al 1996b). It has been argued that the task of defining the term supervisor is made more complicated by the fact that other(a) ground are used, such as assessor, facilitator and mentor, to describe the same role (Phillips et al 1996a, Phillips et al 1996b). As a result of the wide range of aspects of the role which is vie by a supervisor, it can be stated that a definition of supervisor can only be a general description as whateverthing more particularized would run the risk of excluding important elements of the position (Davies et al 1994). For the purposes of the following review, the definition of supervision which was provided by Zwolski (1982) leave behinding be adoptedSupervision is a relationship which is aimed at guiding the dilettante towards an established place within the commerce (Zwolski 1982)In the nursing profession the aims of the supervisor leave behind be to form a relationship with their nurses which enables them to be successful during their training and throughout their subsequent career. Jarvis (1995) emphasised that it is important to focus on the supervisors role as a func tion and as a relationship with the nurse rather than being about them as a instructor or practitioner. Through this role the supervisor can help to narrow the gap mingled with theory and practice (Pelosi-Beaulieu 1988, Armitage and Burnard 1991). Butterworth and Faugier (1994) theorise that the role of clinical supervisor has trey key elements, to wit pedagogics, Support and Management (through quality control). nevertheless one sentimentualises clinical supervision within practice and district nursing, the benefits of the process have been show through previous research. It has been found that nurses require their supervisor to provide a healthy role model and to provide a source of support, particularly in the earlier years of a nurses career (Gray and smith 2000). Research has indicated that nurses tend to leave the profession because they cannot cope with the demands of training or the job itself (Fulbrook et al 2000) or because of more personal factors (MORI 2003). It whitethorn be that clinical supervision has a broader role to play here in reducing the probability that a nurse ordain leave the profession. ground on questionnaire research, Thomas and Reid (1995) identified five important benefits of clinical supervision. They were support, science development, team building, monitoring clinical performance and the sharing of information. The following review pass on consider research which has focussed on the clinical supervision within practice and district nursing.4.0 METHODA systematic review aims to integrate existing information from a encompassing range of sources, utilising a scientific replicable approach, which gives a balanced view, hence minimising bias (Hart 1998). In other words, a scientific approach will help to ensure that research evidence is either accommodated or excluded based upon well defined and standardised criteria. This should ensure that the possible effects of researcher bias should be kept to a minimum. Brealey and Glenny (1999) likewise states that systematic reviews provide a promoter of integrating valid information from the research literature to provide a basis for rational decision making concerning the provision of healthcare.4.1 SOURCES OF DATAThe methodology employed within the research will involve obtaining entropy from three key sources Computerised searches, Manual searches, and the Internet. to each one of these data sources will now be considered in more detail.4.1.1 COMPUTERISED SEARCHESMultiple databases, both online and CDRom will be feelered to retrieve literature because they cite the majority of applicable texts. (Loy 2000) The computerised bibliographic databases are-MEDLINEEMBASECINAHLPSYCHINFOBritish Nursing Info BNICochraneScience Direct(All Sciences Electronic Journals)However because articles may not be correctly listed within the computerised databases, other strategies will be applied in give to achieve a comprehensive search (Sindhu Dickson 1997).4. 1.2 MANUAL SEARCHESA manual search will be performed to ensure that all relevant literature is accessed. The manual searches will include-Books relevant to the topic from university libraries and web sitesInverse searching- by locating index terms of relevant journal articles and textsSystematically searching reference lists and bibliographies of relevant journal articles and texts4.1.3 THE INTERNETThe internet will provide a ball-shaped billet of the research topic and a searchable database of Internet files stash away by a computer.Sites accessed will include-Department of Health subject area appoint of Clinical Excellence side of meat National Board of Nursing, Midwifery and Health VisitingGoogle4.2 IDENTIFICATION OF KEY WORDSThe selection of search terms is an important task. The search needs to be sensitive in that it should divulge as many of the key articles as possible. It should also be precise in reducing the number of irrelevant articles which it produces. The searc h words were derived based on the research question, as recommended by Loy (2000). They wereClinical SupervisionPractice NursingDistrict NursingEvaluationEffectiveness4.3 INCLUSION AND exception CRITERIA.In order that a manageable quantity of pertinent literature is included in this case, it is essential that inclusion and expulsion criteria are applied. These are outlined below4.3.1 INCLUSION CRITERIAThe articles which are highlighted within the proposed searches will be assessed in terms of whether or not they meet the following criteria. Each article will need to be viewed as take over with regards to all of these constraints if they are to be included in the nett analysis. From the pool of data which is obtained, the most appropriate articles which meet these inclusion criteria will be selected for use within the review.A literature review encompassing all methodologies will be applied (International studies will be includedAvailable in inclineRelate to Clinical Supervisio nRelate to Practice or District Nursing4.3.2 EXCLUSION CRITERIAThe articles highlighted by the searches will also be assessed in terms of whether or not they fulfil the following exclusion criteria. If a potentially relevant article meets one or more of these criteria then they will be immediately excluded from the data set and will not be included within the analysis stage of the methodology.Articles relating to supervision in industries other than health care will not be includedLiterature in a foreign language will be excluded because of the cost and difficulties in obtaining translation.Research inform prior to 1985 will not be included within this review.4.4 CONSIDERATION OF ETHICAL ISSUES any(prenominal) research involving NHS patients/ armed service users, carers, NHS data, organs or tissues, NHS staff, or premises requires the grace of a NHS research ethics charge (Department of Health 2001). A literature review involves commenting on the work of others, work that is prim arily published or in the public domain. This research methodology does not require access to confidential case records, staff, patients or clients so permission from an ethics committee is not required to carry out the review. The researcher will also act professionally when identifying, reviewing and reporting relevant studies.5.0 RESULTSThe most relevant research which was identified by the methodology employed within this research will now be critically analysed. In order to structure the raillery more effectively, the analysis will address the three stages which should comprise the military rating of a training intervention (Kirkpatrick 1979). Thus the discussion will consider the development, implementation and outcomes of clinical supervision in practice and district nursing.5.1 military rank OF THE DEVELOPMENT OF SUPERVISION PROGRAMMESWhenever one is considering a health care intervention, it is important to first address the foundations upon which it was developed. In the case of clinical supervision, one essential consider the relevant policies and a priori frameworks. A set of standards which govern the expression and role of supervisors were produced by the UK Central Council for Nursing, Midwifery and Health Visiting (2004). The English National Board have outlined the five key aspects of the supervisors role Assisting, Befriending, Guiding, Advising and Counselling (Anforth 1992). Research has been conducted with the aim of evaluating the supervision process from a theoretical perspective as well as those of the nurses and supervisors themselves. This research will now be outlined.Researchers have conducted reviews of clinical supervision of nurses and have highlighted almost potential limitations. Andrews and Wallis (1999) report that a range of opposite frameworks for conceptualising the supervisor role were rife and that more specific guidelines needed to be developed. They also found that supervisors a good deal attended short and lo cal courses whose effectiveness had not been evaluated. Furthermore, Wilson-Barnett et al (1995) stated that the continued use of terms such as mentor, assessor and facilitator, as well as supervisor, led to confusion of the specific spirit of the role. Therefore, it appears that although standards have been developed regarding clinical supervision in nursing, moreover work may be required to ensure that they are more effectively disseminated.The process of clinical supervision needs to also be evaluated from the nurses perspective. Watson (1999) conducted semi-structured interviews with 35 nurses to wonder their perceptions of the clinical supervision which they had received. Two key findings were reported. Firstly, the respondents reported that they matt-up that the supervision process was not sufficiently defined by the English National Board. They also felt that the supervision process was not adequately nice by their internal organisation. Standards were seen to be appropri ate but they were not effectively applied to the practical situation. This research did employ a small have and the consummation to which the findings can be generalised to the UK as a undivided may be questioned Having said this, these findings do demonstrate that nurses clinical supervision is based on appropriate standards but that the roles of supervision and the person being supervised need to be more specifically defined.The third and final area of evaluation concerns the supervisors themselves. Cahill (1996) reviewed the relevant research in this area and reported that there are a range of dissimilar supervisor selection and training procedures. This ensures that there is sufficient scope for different supervisors to be selected based on different criteria and for them to then go on and receive different levels of training. This lack of standardisation has the potential to mean that the quality of supervision provided throughout the UK may significantly differ. Further r esearch in this field has been reported.For instance, Neary (1997 and 2000) interviewed one hundred fifty-five clinical supervisors. It was found that there was some confusion over the nature which the supervisor/nurse relationship should take. The supervisors were not clear on what their specific role was and the extent to which they should help their nurses. This causes problems in terms of competency assessment as the supervisors were not clear on what was expected of them and the nurses whom they were supervising. Therefore, issues regarding standardisation and role definition are prevalent within supervisor perceptions of this topic. This section has demonstrated that work is required to improve the dissemination of standards, role definitions and the standardisation of supervisor selection and training.5.2 EVALUATION OF THE IMPLEMENTATION OF SUPERVISION PROGRAMMESA relevant research study which has been conducted in this area involved nurses and their supervisors completing ac tivity diaries for a week (Lloyd-Jones et al 2001). The data provided via the activity diaries were then analysed in order to determine the extent to which the nurses were adequately supervised and what happened when their supervisors were not present. It was reported within this research that the nurses did spend a significant amount of time aside from their supervisor. It was identified that in the absence of a supervisor, the student nurse was lots supervised, either directly or indirectly, by another qualified division of staff. Although this may be a good short term solution, it is flimsy to be standardised across organisations and to only occur when there is an appropriate member of staff available. More strategic approaches to clinical supervision may be required such that practice and district nurses have appropriate support when it is required.The importance of supervisor availability has been highlighted within international research. For example, Saarikoski (2002) col lected data from 558 student nurses who were based in both Finland and the UK. They completed the Clinical Learning Experience and Supervision Instrument. The Finish students were found to be significantly more tyrannical regarding their clinical experience and their supervision relative to the UK students. This deviation was found to be significantly associated with the fact that Finish students spent a significantly longer amount of time with their supervisor. This methodology benefits from using a relatively large sample. Other research has focussed on the extent to which the supervisors themselves are adequately supervised.Aston et al (2001) conducted research which was commissioned by the English National Board. They collected information via documentation, one-to-one interviews and focus groups using samples of 76 lecturers and 46 practitioners. The research focused on the participants perceptions of the extent to which the supervisors of student nurses are adequately superv ised, monitored and audited. It was found that supervisors believed that they were not sufficiently prepared, supported or monitored. They had a wide range of different experiences and they believed that there was a need for a more organised approach which would enable more consistent support and supervision to be available. It is important that the supervisors themselves are supervised so that they have someone to guide and advise them in their role and to provide them with the support that they need to effectively supervise their student nurses. The methodology used in this study benefits from having a relatively large sample and because it obtained data from a number of different sources. This facilitated an overall view of the topic to be gained by enabling a more comprehensive approach. This section has demonstrated that further work is required in the implementation of clinical supervision to ensure that both practice and district nurses, as well as their supervisors, are appr opriately supervised.5.3 EVALUATION OF THE OUTCOMES OF SUPERVISION PROGRAMMESA key area of any evaluation will focus on the relevant outcomes. However, in terms of clinical supervision, this is not a straight forward task as there is a lack of clear and standardised assessment tools. Calman et al (2002) conducted 12 focus groups and 72 one-to-one interviews with nurses and supervisors to gain an understanding of their perceptions. It was reported that assessment tools were not seen to provide a fair reflection of a persons ability and that the approaches taken varied significantly between organisations. As a result of this the research which has empirically assessed the effects of clinical supervision on both the quality of patient care and the nurses skill acquisition is limited.Having said this, questionnaire research involving 19 nurses has highlighted some of the comprehend positive outcomes of clinical supervision (Earnshaw 1995). The respondents indicated that the supervision provided vital support, aided their socialisation in terms of ward culture and facilitated their gaining of clinical experience which helped to improve their skills. Thus, through both direct and indirect methods, clinical supervision can have positive outcomes in terms of the nurses themselves. However, one cautionary note should be made here in that further research by Cahill (1996) has revealed that some nurses view clinical supervision as a form of control and assessment rather than a source of help to them.Therefore, more standardised and validated assessment tools are required before confident conclusions can be made regarding the actual effects of clinical supervision on nurses skills and the quality of the care which they provide to their patients. There are some perceived outcomes of both a positive and prohibit nature which are associated with clinical supervision. Further work here would help to maximise and realise the perceived benefits and to minimise the effects of any possible negative aspects.Other relevant research has focused on the outcomes of clinical supervision in terms of the nurses job cheer. Gray and Smith (2000) interviewed 10 nurses at five different points in their careers. A positive correlation was found between the quality of the supervisor/nurse relationship and the nurses satisfaction with their learning experience within their role. Therefore, if a positive relationship can be facilitated between a nurse and their supervision then this should, in theory, help to improve the materialise that the nurse will be satisfied within their role. Research has also investigated the longer term aspects of the relationship between clinical supervision of the nurses satisfaction with their career. One such study was recently conducted by Pearcey and Elliott (2004) and involved interviews with 14 student nurses. Four key aspects were associated with whether or not the student nurses would be likely to go on and seek a career as a nurse in the future. These factors included ward culture, the reaction to negative incidents, the student nurses perceptions of the qualified nurses/supervisors and how these people were seen to treat the trainee nurses. Thus the supervisors can help to improve the learning experience in each of these areas.This section has shown that improvements need to be made in establishing a standardised assessment to enable more accurate evaluations of the effectiveness of clinical supervision to take place. prevail perceptions of clinical supervision do reveal that there are both positive and negative outcomes. One interesting finding merits consideration here. Andrew and Chilton (2000) interviewed supervisors and nurses regarding the benefits of a teaching qualification on the outcome of clinical supervision. The supervisors reported that they felt that it made them more effective in the supervisory role and that they provided better support as a result of the qualification. However, the nurses ratings of supervisors with and without a teaching qualifications revealed no significant differences. Thus more work is required in ontogenesis the training of supervisors to ensure that it has a positive effect.6.0 CONCLUSIONSThis review has considered research which has evaluated clinical supervision within practice and district nursing. The discussion focussed on the development, implementation and the outcomes of clinical supervision. In terms of the developmental factors, a need for an improvement in the dissemination of standards was identified along with the establishment of clearer role definitions. A drive towards a more standardised approach to supervisor selection and training is also advocated. As for the implementation of clinical supervision, the need for both nurses and supervisors to be supervised was identified. Research has demonstrated that supervisor availability is associated with the nurses performance and hence it is important that supervisors are available a s much as possible.The final section of the discussion considered the outcomes of clinical supervision. The lack of standardised and validated assessment tools ensure that it is difficult to fix the effects of clinical supervision on the nurses performances and ultimately on the quality of patient care. However, the perceived benefits of clinical supervision, such as support, socialisation, enabling clinical experience and enhancing job satisfaction, were identified. It may also have longer term benefits in terms of reducing the probability that a nurse will leave the profession. It is through working towards the realisation of the perceived benefits that clinical supervision can be made as effective as possible. 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