Clinical Supervision Louise Brady Clinical & Strategic Development Lead Practice Nursing NHS Manchester CCG’s Clinical supervision should not look like this!

Why is it important? PATIENT SAFETY First & foremost! Professional Development requirements NMC Revalidation 2015. Clinical supervision in GP Land… What does Clinical supervision look & feel like in your Practice?.......... Discussion with nurses- what happens currently? & where do we need to be?

Frameworks Proctor’s Model of supervision Normative Assure quality & safety Restorative Identify solutions to problems in practice.. Coping mechanisms & dealing with stress Formative Education, professional development, skills & Knowledge. Evidence based frameworks that are used

Applications of the model Normative Observations of care, consultations, triage, tel consults, Skype documentation patient electronic health records. Restorative Group supervision, case conferences, identification of problems, and workable solutions. Formative Educational & Professional development.

Heron’s Model Authoritative Supervision interventions: Prescriptive – direct behaviour Informative – Information giving/ Instruct Confronting - challenge Facilitative Cathartic – release tension, strong emotion Catalytic – encourage self exploration Supportive – Validate/ confirm Talk about models/ how effective are these when applied to clinical practice?

Powell’s Model Components Administrative Evaluative Clinical Supportive Conceptualisation of supervisor as a ‘servant leader’ who is Self aware Operates with focus & energy Proficient in many aspects of the job Shares power & values people by caring.. Partnership approach Useful for primary care nursing? Working in partnership with others?

Assumptions of Powell’s model People have ability to bring about change with assistance People may not always know what they need.. May be blinded by resistance/ denial The key to growth- to blend insight & behavioural change in the right amounts at the appropriate time. Change is constant & inevitable. In supervision as in therapy, the guide concentrates on what is ‘changeable’

Structure of Supervision Individual Group 1 supervisor with 4-6 supervisees Triad 1 supervisor & 2 supervisees Team – colleagues working together outside the group Network – people not usually working together outside the group Practice nurse’s need 2 box clever! Social media? @wenurses What works? Share ideas from group

Current Supervision debates ? From the same discipline ? A different discipline A peer colleague Expertise Guided reflection Vs. more traditional clinical supervision.. Collaborative supervision? May not challenge each other sufficiently ( Walsh et al 2003). What do others think about interdisciplinary learning & sharing? What are your current experiences?

Evidence- supervision effectiveness Supervision has a positive effect on patient outcomes, & lack of supervision is harmful to patients. Self- supervision is not effective. The quality of the relationship between supervisor & supervisee- the single most important factor for effective supervision. Behavioural changes can occur quickly- changes in thinking & attitude can take much longer. ( Kilminister & Jolley 2000)

Characteristics of effective Supervisors Empathetic Supportive, flexible & interested in supervision! Tracks supervisee’s progress Links theory with practice, engages in joint problem solving. Interpretative Respectful, focused practical & knowledgeable. Important to establish relations based on mutual support & trust.

Characteristics of Ineffective Supervisors Rigid, low empathy, low support. Failure to consistently track supervisee concerns. Indirect & intolerant Closed, lacking in feedback & encouragement. Lacks respects for differences, sexist Emphasise evaluation, weaknesses & deficiencies. Surround yourself with people who can support advise & develop

Recommended Support for Supervisor Assessment of learning needs Adult learner/ provision of feedback Counselling Issues of power & social stratification. Trans- cultural relationships.

References Heron, J. (1989). Six category intervention analysis. Guildford: Human Potential Resource Group, University of Surrey. Kilminster, S. M., & Jolly, B.C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34, 827-840. Powell, D. (1993). Clinical supervision in alcohol and drug abuse counseling. San Francisco: Jossey-Bass . Proctor, B. (1987). Supervision: A cooperative exercise in accountability. In M. Marken, & M. Payne (Eds.). Enabling and ensuring supervision in practice. Leicester: Youth Bureau and Council for Education and Training in Youth and Community Work. Sloan, G., & Watson, H. (2002). Clinical supervision models for nursing: Structure, research and limitations. Nursing Standard, 17(4), 41-46. Walsh, K. et al. (2003). Development of a group model of clinical supervision to meet the needs of a community mental health nursing team. International Journal of Nursing Practice, 9, 33-39.

Louise Brady Clinical & Strategic Development Lead Practice Nursing. Louise.brady2@nhs. 07958119543 Twitter: @louisebrady17 Thank you For Listening….