Clinical Supervision Handbook - CAMH Knowledge Exchange ..

Ongoing Clinical Supervision
CASE EXAMPLE: A NURSE IN INDIVIDUAL
CLINICAL SUPERVISION
A nurse on an inpatient unit met with her supervisor to discuss a
client with whom she was having difficulty engaging. This client
had a chronic mental illness and also suffered from diabetes. The
nurse described her interactions with the client and talked about
how she was focusing on the client’s diabetes, which was not well
controlled, and her mental illness. She herself felt as though she
was “nagging” the client “all the time” about the importance of
following a diet to better control her diabetes. The client became
withdrawn and uncommunicative in her interactions with the
nurse. The nurse said she had reached an impasse with this client.
The clinical supervisor explored the nurse’s feelings, as well as
how the client may have been feeling. The nurse felt like a
“nagging parent,” constantly pointing out to the client what she
ought to be doing. She cared for the client and was fearful that the
client’s health would deteriorate further, and she would never get
better if she did not adhere to her dietary and treatment regime.
She also felt a sense of urgency and responsibility, given her timelimited
involvement with the client as an inpatient nurse. If the
client didn’t get better, she wasn’t doing a good job. The client,
she thought, may have felt powerless, frustrated and tired of
“being a patient.” The nurse and the clinical supervisor began to
wonder if her focus on the client’s illness was interfering with her
seeing the client as a whole person and with getting to know her,
beyond her illness. Perhaps that is why the client had withdrawn.
Together they explored an empathic perspective and tried to see
and feel the world as her client was seeing and feeling it. They
wondered: what was it like for her to be ill and in hospital? How
did it feel for her to have so much of her life revolve around “being
a patient”? How did it feel for her to be dependent on others for help
indefinitely? By trying to experience the client’s world from her
perspective, they came up with an intervention aimed at helping
the nurse reconnect with her client. This involved taking the client
off the unit, perhaps for a walk or to the coffee shop (the client
would decide on the activity) in a “less illness” focused context
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