Graham Sloan

A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals

AIM The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. BACKGROUND Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. DESIGN A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. DATA SOURCES Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. REVIEW METHODS Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized in tables. Data describing the key components of clinical supervision interventions were extracted from studies included in Synthesis 2, categorized using a reporting framework and a narrative account provided. RESULTS Ten reviews were included in Synthesis 1; these demonstrated an absence of convincing empirical evidence and lack of agreement over the nature of clinical supervision. Nineteen primary studies were included in Synthesis 2; these highlighted a lack of consistency and large variations between delivered interventions. CONCLUSION Despite insufficient evidence to directly inform the selection and implementation of a framework, the limited available evidence can inform the design of a new model of clinical supervision for UK-based midwives.

Competences for Clinical Supervision in Psychiatric/Mental Health Nursing

This chapter presents a clinical supervision competency framework for nursing based on the knowledge, attitudes and skills approach. The issue of competency of individuals who provide health and human services has received increasing attention over the past decade, yet even though nursing has a long history of embracing clinical supervision, identification of and consensus on what competences are necessary for clinical supervision in nursing remain lacking. Accordingly, literature on clinical supervision published from 1996 to 2012 was searched using CINAHL, Medline, Psychlit and British Nursing Index. A manual scrutiny of relevant textbooks, and literature that originated in related disciplinary areas that are ‘outside’ of nursing, was systematically reviewed and identified competencies were categorised into knowledge, attitudes and skills. While there is currently no consensus as to the required core competencies for clinical supervision in nursing, our review identified a variety of knowledge, attitudes and skills that have been posited as part of the competency ‘framework’. There is substantial evidence of ‘overlap’ or replication of competencies between literatures; in some cases, the same (or equivalent, analogue) competencies were located in many different papers. Three issues arise: (1) the absence of broad consensus regarding the competencies required for clinical supervision in nursing can be addressed, at least in part, by embracing the knowledge, attitude and skills approach and undertaking an international Delphi study based on this framework; (2) competency models being advanced must include attention to the acquisition and/or development of required qualities in addition to skills and knowledge; and (3) it appears that competencies are being advanced for radically different degrees of clinical supervisor (and supervisee) training/preparation/practice. Current literature alludes to effective knowledge, attitudes and skills that inform the practice of effective clinical supervision. This paper presents a synthesis of this literature in the form of a minimum competency framework for supervisory practice in nursing.

An Introduction to the Art and Science of Cognitive Behavioural Psychotherapy

This chapter focuses on the theory and practice of cognitive behavioural theory (CBT) and psychotherapy, and it begins by exploring the empirical foundation of CBT. Following this the authors describe and consider key methods and techniques used commonly by CB therapists or P/MH nurses who wish to use CBT skills and interventions, namely, the therapeutic relationship, assessment strategies, case conceptualisation, structure, cognitive techniques and behavioural interventions. The chapter also considers competence in CBT and how to develop competence before reminding readers of the necessity and value of engaging in clinical supervision. Finally, the authors speak to how P/MH nurses can use CBT skills and techniques in a variety of mental health settings. They conclude that P/MH nursing curricula in the Occidental world invariably include material and experience of CBT skills, theory and techniques, and mental health service users overwhelmingly state their desire for more ‘talk therapy’. Accordingly, while P/MH nurses might not necessarily use all the skills, techniques and interventions captured in this chapter, there is a broad consensus in the relevant theoretical, clinical, empirical and policy literature that P/MH nurses in various settings can and should consider the more widespread use of CBT skills—even though the authors acknowledge that this is not without challenges and the need for some adaptation.