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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. 111
Clinical Supervision Handbook A competent supervisor is conscientious about recording processes that specify content, about knowing who has a right to access information, and recognizing what constitutes good practice. The maintenance of personal reflective diaries enabled supervisors to define their own needs for supervision, clarify expectations, and further develop their skill in supervision. In summary, clinical supervision researchers in nursing conclude that clinical supervision is necessary for safe and effective nursing practice and can lead to personal and professional development (Arvidsson, et al., 2001; Berg & Hallberg, 1999; Kelly & McKenna, 2001; Rafferty et al., 2003). Nurses, managers and supervisors agree that the process and format vary depending on the organizational context in which clinical supervision takes place (Arvidsson, et al., 2001; Berg & Hallberg, 1999; Jones, 2003; Kelly & McKenna, 2001). Commonly identified elements are: • positive interpersonal relationships • affirmation of appropriate practice • deliberate scheduling of time and space • reflection and provision of specific applied knowledge • organizational support • staff accountability. CONCLUSION A comparison of the social work and nursing literature on clinical supervision reveal common elements in the approaches offered by Kadushin’s model of three interrelated functions of social work supervision and Proctor’s three-function interactive model of nursing supervision. Both models of supervision include an administrative, supportive and educational component that can lead to increased accountability and feelings of personal support. A significant difference between social work and nursing supervision is the lack of consensus about the definition of clinical supervision in nursing. What is more, the logistical realities of nursing, including time away from clients, rotating shifts, 24-hour care and stringent time-oriented duties make it challenging to implement clinical supervision within a nursing environment. By comparison, in many social work agencies, the daily activities of social work are exempt from many of these constraints and offer an environment more conducive to regularly scheduled clinical 112
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