Critical Discussion On Clinical Supervision, Clinical Support Methods, And Their Strengths And Limitations

Critical Discussion on the Practice of Clinical Supervision

Discuss about the Clinical supervision.

Clinical supervision is related to the practice of bringing in skilled supervisor and medical practitioners to engage in one-on-one, group or peer supervision for the purpose of practice improvement, resolving professional issues and identifying solutions to clinical issues. The approach to supervision differs on the basis of area of practice, experience of supervisee and purpose of supervision. This form of working alliance is required to develop the competence and confidence of health care staffs and helps them to deliver safe and ethical care (Gopee, N. (2015). On the other hand, clinical support such as debriefing is related to a counseling approach by which interaction between staffs and supervisors helps to understand the impact of traumatic event and teaching staffs to deal with difficult situation in health care setting. The purpose of this report is to critically discuss strength and weakness of clinical supervision and clinical support approach and determine the difference between both the approaches.

Clinical supervision is particularly applied in mental health service as there are many ethical challenges faced by health care staff in the service. Clinical supervision contributes to professional development of clinicians and enhancing their ability to deliver ethical and safe care. The dimensions of clinical supervision differ in different context. For example in nursing, it may mean supervising newly placed nurse in mutual communication, patient support and delegation skills (Bogo et al., 2011). The structured approach to clinical supervision for nurses in mental health care setting includes using reflective practice and shared experience to support continuous professional development. To enhance clinical skill of nurse, reflecting skill is often taught during clinical supervision to help them learn from their experience and develop their care approach in the future (Bradbury?Jones et al., 2009). The three important components of clinical supervision include the following:

• Enhancing formative functions- This form of clinical supervision relates to the holistic professional development of practitioners by means of reflection of practice and developing the ability to improve performance by means of relevant guidance from health care staffs.
• Supporting restorative functions- By this approach, supervisors builds a supportive relationship with the staffs to help them deal with emotional issues such as neglect, conflict or low-self esteem in clinical practice. Sharing of professional concerns and difficulties helps to support them in enhancing their confidence and skills.
• Supporting normative functions of staff- In this area, the main role of clinical supervisor is to make staffs aware of professional, legislative and policy requirements in clinical practice so that they develop their skills and competencies accordingly to manage risk and comply with organizational responsibility (White & Winstanley, 2009).

Strength of clinical supervision- The main advantage of the clinical supervision approach in health care organization is that it enhance staff competence level in practice and promotes positive outcome for clients. Mental health workforce is often challenges by complexities of mental illness and effective supervision process has helped them to overcome issues in care. This lead to reduction in job turnover rate and increase in satisfaction with the job. Effective clinical supervision given to nurses in clinical practice helps to identify and translates values and principles of care in daily practice.

Limitations of clinical supervision- There are certain limitation of clinical supervision too. The critical evaluation of clinical supervision in psychiatric nursing mainly revealed that there is lack of agreements about appropriate models to be used in nursing practice. Hence, this questions the efficacy of the clinical supervision in psychiatric nursing (Buus & Gonge, 2009). There are also issues related to professional regulations and quality standards that influences clinical supervision practice. Medical practitioners also regard clinical supervision as threatening from of surveillance and there is a need to change the mind set of clinical staff so that they take supervision process with a positive mind set to develop their professional expertise. It gives them a reflective opportunity to present the issues to their supervisor and deal with challenges in practice. Furthermore, despite adequate clinical supervision, some time the purpose of supervision is defeated due to lack of transparency in organization. Hence, to make the clinical supervision process successful, it is necessary to establish transparent health care system with required quality health service provisions (Clouder & Sellars, 2004).

Critical Discussion on Two Clinical Support Methods

Clinical support is not related to clinical supervision, rather it is a form of professional consultation to seek support certain expert groups to get important input on specific case and continue to enhance professional growth and development. Two examples of clinical support include mentoring and debriefing process. Clinical debriefing process is an important learning tool in health care where a patient situation is discussed with another expert and reflective process follows to determine the factors that can improve future performance. Simulated environment is specially required in improving teamwork in operating room to avoid confusion and disruptive behavior that may pose risk to patients. High-fidelity simulation based training is necessary to promote team based attitudes and interaction during treatment of patients. It involves setting realistic scenarios during debriefing discussions and giving each participant the opportunity to immerse in a realistic environment. This helps team to realize the consequences of actions to manage difficult situations involving real patients (Gururaja et al., 2008).

Clinical mentoring is another form of clinical support by which health care workers get the opportunity to bridge the gap between didactic training and effective clinical support. It is structured pathway by clinicians can develop their skills by overcoming barriers in care and utilize their knowledge to achieve positive outcome in care. The clinical mentors are involved in one-on-one case management observation, reviewing clinical based records and then reinforcing relevant skills to staffs. It mainly involves shared goal development and informal way of teaching to learn from past experience and acquire the ability to improve past events in future (Anatole et al., 2013).

Strength and limitation of debriefing process- Clinical post-event debriefing is an effective approach to enhance patient care and improve individual as well as team performance. Some limitations of debriefing process in hospital is that they often overemphasize on debriefing process after a rare event and individual attention is not given so that staffs acquires the skill required for quality care. Many a time debriefing process is ineffective when clinicians and nurses fail to find relation between their clinical simulation education and actual practice. Hence, to make the process beneficial, it is necessary to provide the resource and support to translate relevant lessons from debriefing sessions into actual clinical setting. This limitation points out to the need of expanding the scope of debriefing strategies in clinical setting and supporting busy clinicians and nurses to effectively implement debriefing lesions in daily practice (Eppich et al., 2016).

Strengths and Limitations of Debriefing Process

Strength and limitation of mentoring process- Clinical mentoring is important in health care as it helps health care staffs to engage in collaborative learning with mentors to share accountability for the positive outcome of any intervention. It is beneficial in the stage of transition from the novice stage to the expert stage. The challenges for novice nurses and clinician is that they tend to just follow the applicable standards of professional practice and follow this standards without considering the context of the situation. Hence, lack of experience hinders their ability to contemplate the whole picture and consequences of any action. Often they are concerned with task in one hand and make errors when they are overburdened with too many responsibilities. The clinical mentoring process helps in them to learn new skills and identify the consequences of any action. With proper mentoring, they progress from advanced beginner to an expert in their tasks (Chen and Lou, 2014).

Clinical mentoring program also has certain limitations such as earlier there were no regular meeting arrangements and staffs hesitated to contact their mentors for support. Personal factors such as relational difficulty also act as a barrier in successful mentoring process as some staffs feel it derogatory to take help from mentors. However, there is a need to make them understand this is not a process to highlight their weakness in clinical skills, but it is an approach to support them in expanding their scope of practice. Hence, redesigning mentoring program with focus on easy retention of information might encourage mentees to participate in large numbers in mentoring program to improve clinical outcome (Lin et al., 2015).

After examining the approach to clinical support and clinical supervision practices in health care setting, it be said that there are certain differences in both the approach. For instance, clinical supervision can take place either by one-on-one interaction or by group wise interaction, but mentoring process is exclusively one-on-one interaction. Secondly, there is power relation difference in supervision and mentoring because supervisors have the power to exercise their influence on outcomes; however mentoring process is related to shared learning experience where mentees consult with mentors to improve outcome and professional development. In clinical supervision, the main goal of the program is often set by the supervisor or regulatory agency in health care setting, while in mentoring process, the shared goal is developed based on challenges observed in real health care practice (Habegger, Knoepfel, & Muir, 2017). Another important differentiation between the two approaches are that clinical supervision is form of direct guidance to enhance clinical skills in practice, whereas mentoring process is an informal teaching method to engage in collaborative skill development (Sundler et al., 2014).

Strengths and Limitations of Mentoring Process

Therefore, clinical mentoring is an intense interaction between two people where there is no influence of power or hierarchy in mentoring relationship and it promote collaborative approach to care process. Hence, clinical supervision has the influence of power which might not be successful if appropriate model of care is not successfully integrated. However, the advantage of clinical support is that it provides the opportunity to health care staffs to share their experience and consult to learn the best approach to react to a complex clinical situation (Henning et al., 2015).

Conclusion

From the comprehensive critical discussion of the clinical support and clinical supervision practices in health care setting, it is understood it is beneficial for skill development and professional growth of health care staffs. However, problems or limitations in approach arise when several factors that hinders success of the program is not considered. There is a need to make the health care system more transparent so that a health care staff realizes the benefit of supervision and mentoring process. Structural changes are also required as often mentoring lessons are not translated into practice due to the lack of institutional and equipment support to enhance clinical outcome of patients.

Reference

Anatole, M., Magge, H., Redditt, V., Karamaga, A., Niyonzima, S., Drobac, P., ... & Hirschhorn, L. R. (2013). Nurse mentorship to improve the quality of health care delivery in rural Rwanda. Nursing Outlook, 61(3), 137-144.

Bogo, M., Paterson, J., Tufford, L., & King, R. (2011). Interprofessional clinical supervision in mental health and addiction: Toward identifying common elements. The Clinical Supervisor, 30(1), 124-140.

Bradbury?Jones, C., Hughes, S. M., Murphy, W., Parry, L., & Sutton, J. (2009). A new way of reflecting in nursing: the Peshkin Approach. Journal of Advanced Nursing, 65(11), 2485-2493.

Buus, N., & Gonge, H. (2009). Empirical studies of clinical supervision in psychiatric nursing: A systematic literature review and methodological critique. International Journal of Mental Health Nursing, 18(4), 250-264.

Chen, C.M. and Lou, M.F., 2014. The effectiveness and application of mentorship programmes for recently registered nurses: a systematic review. Journal of nursing management, 22(4), pp.433-442.

Clouder, L., & Sellars, J. (2004). Reflective practice and clinical supervision: an interprofessional perspective. Journal of advanced nursing, 46(3), 262-269.

Eppich, W. J., Mullan, P. C., Brett-Fleegler, M., & Cheng, A. (2016). “Let's Talk About It”: Translating Lessons From Health Care Simulation to Clinical Event Debriefings and Coaching Conversations. Clinical Pediatric Emergency Medicine, 17(3), 200-211.

Gopee, N. (2015). Mentoring and supervision in healthcare. Sage.

Gururaja, R. P., Yang, T., Paige, J. T., & Chauvin, S. W. (2008). Examining the effectiveness of debriefing at the point of care in simulation-based operating room team training.

Habegger, M., Knoepfel, E., & Muir, M. (2017). A comprehensive approach to clinical mentoring. Retrieved 10 March 2017, from https://file:///C:/Users/admin/Downloads/Habegger-Knoepfel-Muir.pdf

Henning, J. E., Gut, D., & Beam, P. (2015). Designing and implementing a mentoring program to support clinically-based teacher education. The Teacher Educator, 50(2), 145-162.

Lin, C. D., Lin, B. Y. J., Lin, C. C., & Lee, C. C. (2015). Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks. Medical education online, 20.

Sundler, A. J., Björk, M., Bisholt, B., Ohlsson, U., Engström, A. K., & Gustafsson, M. (2014). Student nurses' experiences of the clinical learning environment in relation to the organization of supervision: a questionnaire survey. Nurse education today, 34(4), 661-666.

White, E., & Winstanley, J. (2009). Clinical supervision for nurses working in mental health settings in Queensland, Australia: a randomised controlled trial in progress and emergent challenges. Journal of Research in Nursing, 14(3), 263-276.