Wicked spell or magic bullet? A review of the clinical supervision literature 2001–2007
Introduction
Accounts of clinical supervision and its value to nurses first appeared in the literature 17 years ago (Hill, 1989). The first text book on underlying theories and practical models emerged three years later (Butterworth and Faugier, 1992). Investigation into the subject has progressively developed since that early and innovative work until the present, where the potential effect that clinical supervision might have on patient outcome (Bradshaw et al., 2007) and the disposition of qualified clinical staff is generating interest. These new and developing trends offer timely opportunities for a literature review and a contemporary comment on progress.
Section snippets
Background
There is a sustained view that clinical supervision has become an important part of nurses’ practice (Tilley and Chambers, 2003, Lindren et al., 2005). Several authors have argued that clinical supervision enables nurses to cope better with the changing nature of health care delivery including an increased emphasis on clinical governance (Wood, 2004, Marrow et al., 2002), decentralisation of decision-making (Hyrkäs et al., 2003) and movement towards community based care (Magnusson et al., 2002
Aims of this review
Clinical supervision is seen to be an important part of nursing activity. There has been little recent analysis of the purposes to which it has been put and if new findings are emerging from its implementation.
This literature review aims to
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offer an analysis of themes arising from the literature that have emerged during the last six year period;
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describe any emerging trends and outcomes that are precipitated through the use of clinical supervision.
Literature review method and parameters
PubMed, CINAHL, Pre-CINAHL, Academic Elite were exhaustively searched for the terms “Clinical Supervision” combined with “Nurse”, “Allied Health Profession” and professions listed by the Health Professions Council. The literature survey was confined to papers published between 2001 and February 2007. Literature before 2001 is only offered when it contributes to the discussion of the current literature. This paper builds on Gilmore, 1999, Gilmore, 2001 presentation of the issues surrounding
Reports on levels of engagement in clinical supervision
Table 1 suggests reported current levels of engagement in clinical supervision. This varies widely (18% in practice nurses in Leicestershire in the UK to 85.9% for mental health nurses in Northern Ireland). This table suggests that the number of nurses receiving clinical supervision varies greatly between regions and disciplines. Many would argue that at the levels described in the tables below, nurses continue to receive an inadequate amount of supervision.
A number of studies have examined
Clinical supervision as an educational and supportive device
The educational and supportive nature of clinical supervision is the most frequently discussed and reported theme in the literature.
Nurses who have experienced clinical supervision suggest that some of the most important advantages are restorative. In qualitative evaluations of clinical supervision, they cite the growth and development of personality (Žorga, 2002), increased confidence (Marrow et al., 2002, Žorga, 2002) and a decreased sense of professional isolation (Bedward and Daniels, 2005,
Ethical debate, personal and organisational challenges
There is an ongoing debate in the literature about the ethical dilemmas produced by clinical supervision. Several authors have argued that part of the function of clinical supervision is to improve practice and create a workforce that is aware of ethical dilemmas. Reflection, it is suggested, leads to ethical decision-making based on three core themes: ‘Is it safe?’ and taking into account rules, codes and values, ‘Is it right?’ and ‘Is it kind?’. Berggren et al. (2005) suggest that clinical
Effects on patient outcome and staffing disposition
It is suggested that “The impact that clinical supervision has on patient outcome is one that tantalisingly remains out of reach” (Carson, 2007). This is true and reported research and development in this area is limited, however important moves are being made to test effects on patients and clinical outcomes. These may be progressed in three ways: (i) by recording clinical interventions that are seen to improve patient care, (ii) by measured change to patient outcome and (iii) as part of
Commentary
The thematic areas explored in this review offer interest. Some work clearly shows professional self-interest, others raise questions of application and implementation. There are some rather ‘tired’ discussions offering no new insights but encouragingly, new ideas relating to patient outcome and professional development are emerging. Employer organisations are beginning to be identified as critically influential.
Levels of engagement carry a number of confounding factors. They are likely to be
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