Clinical Supervision Handbook - CAMH Knowledge Exchange ..

Conceptualization of Clinical Supervision: A Review of the Literature
skill mix. In contrast, Kelly et al., (2001) found that one-on-one clinical supervision
was the commonly adopted approach by three-quarters of their sample of nurses
in Northern Ireland. Group supervision was offered to only seven per cent of nurses
surveyed.
Factors contributing to quality of supervision
In investigating the factors that contribute to the quality of supervision, Berg and
Hallberg (1999) found that quality depended on the supervisor’s ability to encourage
and create a permissive atmosphere while Kelly and McKenna (2001) identified the
importance of training. They found that 100 per cent of managers and more than
90 per cent of supervisors and clinical psychiatric nurses strongly supported the
need for supervisor training. They also found an overwhelming majority of all
participants agreed that managers are not the best supervisors.
Rafferty, and colleagues (2003) used a modified Delphi method with expert clinical
supervisors to elicit their perceptions about the multi-dimensional aspects of clinical
supervision and to achieve some consensus about crucial components. They found
three main factors that contribute to effective supervision:
• professional support
• learning
• accountability.
Professional support refers to use of time, supervisory environment and mutuality in
the relationship. Supervisors demonstrated the value of supervision by maintaining
appointment times and defining supervision as part of the work. A positive supervisory
environment was defined as offering consistency, comfort, privacy and the absence
of inappropriate distractions. Relationships were built on mutual respect, choice and
negotiation of ground rules.
The second factor is learning, which refers to focus, knowledge and interventions.
Supervisors assist supervisees to articulate, reflect and make meaning of their activities,
which promotes safety and effective nursing care. Knowledge is enhanced when
supervisors elicit explanations and identify supervisees’ abilities and needs for professional
development, when they affirm appropriate practice, support professional
esteem, and encourage the continual need for achievable challenges.
The third factor is accountability, which refers to organizational support, recording,
and competency. The organization must provide the commitment and resources
to enable supervisees and supervisors to receive or offer appropriate supervision.
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