Clinical Supervision: Roles, Responsibilities And Ethical Considerations

The Concept of Clinical Supervision

Question:

Discuss about the Clinical Supervision Plan and Skill.

Clinical supervision refers to the valid informal learning activity. The clinical supervision helps to bring the skilled supervisors and the practitioners to reflect the practices of them (Butterworth & Faugier, 2013). The clinical supervision helps the nurses to assess their knowledge and skills so that they can develop the caring process and improve the quality of life. The clinical supervision provides education to the nurses as well as protects the clients.  Hence, the nurses need to maintain the guidelines of the clinical supervision.

In the assignment, the discussion focuses on the concept of the clinical supervision. The model of the clinical supervision is described. The discussion shed light on the ethical and legal principle as well as the professional code. The practice of clinical supervision is discussed. The clinical supervision has different roles in different context that are discussed in the assignment. The clinical supervisors need to have self- awareness and problem solving ability that are discussed.

Supervision is mainly used in the psychological, counseling, and other mental health disciplines. The professionals may engage in working with the people. Supervision can be applied to the practitioners in the somatic disciplines for the preparatory work (Haynes, Corey & Moulton, 2013). This can relate to the patients. Supervision delivers the skills of supervised practitioners. It can consist of practitioners to meet the expectation of the regular needs of the clinical supervision.

The hidden relationships in the supervision process may lead to legal implications. Thus, the supervisor should attempt to protect all the concerned parties with openness for making adjustments in supervisory relationships for providing benefits to the supervisee, clients and counselor as well as for meeting the objectives of clinical supervisor process. As a part of supervisor’s competence mandate, the supervisor needs to determine the personal readiness to lead to the role or supervisor and therapist. The clinical supervisors need to have self- awareness. It helps to explore the unexamined judgments. The unexpected judgments are difficult in spotting and provide the supervision.

The main aim of the clinical supervision is to acquire knowledge as well as the skills for the treatment of the patients. This can help to improve the relationship in between the clinical professionals and the patients or service users. In case of patient care, the supervision is necessary to improve the condition of the patient. This will help to develop the professionalism of the clinical personnel and maintain the ethical standards. In the present years, the clinical supervision helped to develop the quality and assurance about the patient care. The clinical supervisors have some duties and responsibilities that are to manage the patient load and patient care. 

Clinical supervision involves multiple relationships, with similar importance, however, sometimes; supervisors become unable to provide similar attention to each relationship, which creates an imbalance, leading to ethical issues (Inman et al., 2014). Thus, understanding of the ethical and legal principles and considerations are helpful to the supervisor to conduct the supervision successfully. The ethical principles include the beneficence, justice, and nonmalniference. Beneficence is the concept that states the duties and responsibilities. The welfare of the participant’s needs to be considered. The professionals need to maintain the justice and avoid the discrimination (Boundary Crossings and Violations in Clinical Settings. 2017). The professionals can face various boundaries like communication gap, insufficient knowledge and other problems. These problems can be overcome via the training.

Roles and Responsibilities of Clinical Supervisors

On the other hand, the supervisor’s competence is another ethical aspect, critically important for the success of the clinical supervision (Rousmaniere & Renfro-Michel, 2016). While following the standard of the practice, supervisor needs to be an expert in the process of clinical supervision; supervisor receives training for gaining the excellence in performance of the supervision as well as evaluation of the supervision process. In addition, it is the liability of the supervisor to provide experiences for stretching the ability of the counselor, while making no harm to the client, maximizing the client’s right as well as offering a standard care practice (Jordan et al., 2015). Other ethical principle says that supervisor must take the obligation to the client, the public, the profession and the supervisee, whenever a close call is being made.

For the supervision to make successful, both the counselor and supervisor may face issues regarding inappropriate dual relationships as it may increase the potential for exploitation or impairs professional objectivity. Therefore, the supervisors should always be diligent about avoiding any situation that may put client, counselor or supervisee at risk of exploitation or increases the probability of reducing his objectivity (Morgan et al., 2015). However, the supervisors should not be scared to hide dual relationships as it leads to rigid interpretations of ethical standard. The hidden relationships in the supervision process may lead to legal implications. Thus, the supervisor should attempt to protect all the concerned parties with openness for making adjustments in supervisory relationships for providing benefits to the supervisee, clients and counselor as well as for meeting the objectives of clinical supervisor process (Martino et al., 2016).

As a part of supervisor’s competence mandate, the supervisor needs to determine the personal readiness to lead to the role or supervisor and therapist. Another most important ethical consideration in clinical supervision is the informed consent, which is the key to protect the supervisor or counselor from a malpractice lawsuit. Moreover, due process is a legal liability of the supervisor, which insures individual’s rights and liberties (Falender, Burnes & Ellis, 2013). Therefore, while signing the informed consent, supervisor becomes liable to maximize and protect client’s right. Finally, confidentiality is another liability of the supervisor, which indicates that supervisor is liable to keep the client’s and counsellor’s information confidentially, breaching of which leads to breach of law (Daniel, Borders & Willse, 2015).

According to Inman et al., (2014), the professional and ethical codes for clinical supervisor guide the following works for the supervisors. According to these codes, the clinical supervisor should ensure that supervisees inform their clients regarding any status regarding the clinical practice including any kinds of restrictions for supervise, regarding license. The supervisor must inform the supervisee regarding process of supervision the goals, case management and evaluation process along with the supervision models being used in the procedure. Supervisor needs to keep all the supervision records confidentially and inform the supervisees regarding the areas of expertise, training, and credentials (Farber & Hazanov, 2014). The supervisor should establish procedures with supervisees for handling crises and give appropriate and timely feedback to the supervisees as a result of evaluation plan established in the process (American Psychological Association, 2015).

Ethical and Legal Considerations of Clinical Supervision

The professional codes for clinical supervisor say that supervisor must interfere with any situations, where the supervisee is impaired and client is at risk. Supervisors are liable for providing only supervision in the professional services, in which field they got training and experience. Moreover, the supervisor is liable to ensure the awareness of supervisee regarding the ethical and legal standards related to their professional codes of practice in the practice field (Fleming & Steen, 2013). Supervisor needs to ensure that both supervisee and clients have significant understanding regarding their rights and legal standards for regulating their professional practice. Supervisor is also bound to provide assistance to supervisees, unable to provide competent clinical services to clients.

The international panel of the experts represents the mental health field, which provides the activities and the best practices. This allows the therapists to serve in a better way. In such context, it is necessary to mention that the number of patient and issues are increasing with the time (Falender et al., 2014). The clinical skills are easy to observe. The clinical supervisors need to have self- awareness. It helps to explore the unexamined judgments. The unexpected judgments are difficult in spotting and provide the supervision. Moreover, the clinical supervision helps to be self- aware (Hardy, Simpson?Southward & Waller, 2017). It helps to solve the problems of patients as well as nurses. The numerous activities, which are experimental, include the help of the supervisors and mental health professionals. They supervise to develop the skills and techniques of the nurses. The reason behind this is to develop the self – awareness in the nurses. Moreover, the clinical supervision helps to develop the intuition, empathy, mindfulness, multicultural awareness, and perspective taking (Neshuku & Justus, 2016). In case of patient care, the self- awareness plays the major role.

Self- awareness is necessary for the professional nurses.  It helps the nurses to find out the strengths and weaknesses of them. Thus, the nurses become able to develop their weaknesses. As mentioned by Tson & Goodyear (2014), clinical supervision helps the professionals to develop their skills so that they can understand the problems of the patients and solve them. The clinical supervision provides the strength to the professionals to communicate in a proper way with the patients. In case of the patient care, the communication is important. Miscommunication can hamper the patient- professional relationship (Falender, Burnes & Ellis, 2013). The self- awareness helps to develop the thinking of the nurses and thus develop the ability of them. When the nurses become self- aware, they will be able to handle the critical situations as well as the patients and its family members. The nurses needs to be aware about their emotions and should have the ability to control it. The self-aware nurses can control the emotion and the patient load (Butterworth & Faugier, 2013). The self- awareness provides the capability to the nurses to understand the problems of the patients and solve the issues.

Clinical supervision is used in various clinical settings, which include counseling, psychotherapy and other health disciplines (Martino et al., 2016). Moreover, several professionals engaged with the care users also needs clinical supervision. The key purpose of the clinical supervision is to support the professional for learning from the experiences gathered as well as the progress in his expertise, while ensuring the provision of excellent service to the care users. It helps to improve professional’s skills and competencies in his practice settings. There are several models of developed by several theorists, which depict the usefulness of clinical supervision in practitioner’s career and overall performance improvement. For instance n 1985, Peter Hawkins with the association of Robin Shohet developed an integrative process model for professionals’ supervision, known as “Seven eyed model of supervision”, which is used internationally in a variety of helping professions (Daniel, Borders & Willse, 2015). The model supports the coaching or mentoring to develop expertise in several levels of knowledge which significantly enhances their effectiveness in performance. This model helps to focus on several key element in the coaching, mentoring process as well as systems where these processes are being operated. This model helps to develop a connection between beliefs, feelings and energetic experience of the coach/mentor with the interactions in the coaching/mentoring process as well as within the supervisory relationship itself (Wong, Wong & Ishiyama, 2013). These seven eyes are as follows:

• The Coach/Mentor/Supervisor system
• The Coach/Mentor/Supervisor interventions
• The relationship between the Coach/Mentor/Supervisor and their client
• The Coach/Mentor/Supervisor’s own experience
• The Parallel Process
• The Supervisor’s own self-reflections
• The Wider Context

The major benefit of using this model in clinical supervision to the mentors and coaches is to gain deeper and wider knowledge in their practise settings, which allows more work flow (Refer to appendix 1). Within these seven eyes, any of one eye a mentor is looking through, will lead to a different facet of the whole (Schoenwald et al., 2013). This model attempts to focus on the interplay between relationships and their context within the wider system and indicates that a supervisor needs to understand the aspects of each eye during clinical supervision (Butterworth & Faugier, 2013).

Clinical supervision is practices in wide range of disciplines; for instance, social work, nursing, psychology, counseling and others, although, each field contains their own idea of clinical supervision. It allows the supervisee to concentrate on a specific aspect of their clinical practice in standard way. Clinical supervision provide support and advise to the supervisee to learn alternative ways of working and exploring specific skills to achieve success. It is significantly practices in mental health and social care settings, where clinical supervision allows the health professionals to work according to professional, ethical and legal framework as well as to shape his future actions in the clinical settings in right way (Fleming & Steen, 2013). Based on supervisor’s feedback, this procedure allows the supervisee to improve the areas of weakness and build on the knowledge in the practice field.

Clinical supervision emerges as crucible. In the crucible, the counselors obtain the knowledge and the skills for treatment. In such case, the professionals provide the basic knowledge to the nurses so that they become self- aware and develop the skills. The focus of the clinical supervision is to develop the skills of the nurses via the teaching, mentoring, and consulting the functions of the clinical supervisions. Ellis et al. (2014) stated that the clinical professionals educate the patients about the diseases and the problems. The development of the clinical supervision is necessary for the patient care.

The clinical supervision helps to develop the skills and techniques of the professionals. This development of the professionals helps to develop the organizational condition and reputation (American Psychological Association, 2015). When the nurses and professionals are able to handle the patient load and manage the issues of the organization, it can help the organizational development.  The clinical supervision provides the value, integral development, and benefits to the organization. The clinical supervision helps to achieve the organizational goals , values and philosophy of care as well as the quality of care (American Psychological Association, 2015).

The nurses and professionals become able t develop their personal skills via the clinical supervision. The clinical supervision is an important part of the treatment of the mental health problems and substance abuse (Fleming & Steen, 2013). This helps to guide the professionals to design the care plan for the patients.  The successful clinical supervision plan helps in the development of the personal skills and quality of service and caring. It helps to address the mental health issues and risks. The clinical supervision helps to improve the reputation of the professionals and the organization (Corey et al., 2014).

The clinical supervision helps the service users as well as the professionals. The clinical supervision develops the skills and techniques of the professionals, which provides benefits to the patients. As a result, the heat condition of the patients develops (Borders et al., 2014). They can lead a healthy lifestyle. The patients can share their concerns with the professional and the professionals can solve the issues of the patients, which helps them in the development of the health issues. In such way, the clinical supervision helps in the outcomes for the consumers (Fleming & Steen, 2013).

The main principle of the clinical supervision is to ensure the patient about the quality of the care. Moreover, the clinical supervision can help the clinical staffs to continue their professional development in the systematic and well planned manner. In view of Wong, Wong and Ishiyama (2013), in case of the patient care, the clinical supervisors need to be more careful about the quality of care and patient management capacity. The principle of the clinical supervision promotes the client welfare. As the therapist, the supervisor needs to support as well as encourage and educate the patient about the treatment. Supervision delivers the skills of supervised practitioners. It can consist of practitioners to meet the expectation of the regular needs of the clinical supervision. Self- awareness is necessary for the professional therapist.  It helps the therapist to find out the strengths and weaknesses of them. The clinical supervision helps the service users as well as the professionals (Daniel, Borders & Willse, 2015).

The clinical supervision develops the skills and techniques of the professionals, which provides benefits to the patients. Understanding of the ethical and legal principles and considerations are helpful to the supervisor to conduct the supervision successfully. Therefore, the first ethical consideration for the clinical supervisor is to meet the purpose and needs to the triadic relationship, by creating a balance between the counseling needs of the clients and the training needs of the counselor. It helps to solve the problems of patients as well as nurses. The numerous activities, which are experimental, include the help of the supervisors and mental health professionals. They supervise to develop the skills and techniques of the nurses. The successful clinical supervision plan helps in the development of the personal skills and quality of service and caring. It helps to address the mental health issues and risks. Several professionals engaged with the care users also needs clinical supervision (American Psychological Association. 2015). The key purpose of the clinical supervision is to support the professional for learning from the experiences gathered as well as the progress in his expertise, while ensuring the provision of excellent service to the care users.

To complete the research, the researcher may face various issues, which may need ethical consideration. Therefore, the researcher needs to take some strategies and maintain the ethics to conduct the research. The research ethic can include the Data Protection Act (1998) (Onwuegbuzie and Leech 2012). This will help to maintain the problems and solve them to meet the ethical ethics and consideration. This can help to improve the quality of the research work. It is necessary to make sure that participants will not be forced in participating in the study work. Participants should have the rights to discontinue participate in the work. Moreover, it is necessary to store the collected data safely to maintain the Data Protection Act (1998) (Morgan 2012).

Conclusion

The clinical supervision provides education to the nurses as well as protects the clients. It can consist of practitioners to meet the expectation of the regular needs of the clinical supervision. The clinical supervision provides the strength to the professionals to communicate in a proper way with the patients. The self-aware nurses can control the emotion and the patient load. . The self- awareness provides the capability to the nurses to understand the problems of the patients and solve the issues.  The model of clinical supervision supports the coaching or mentoring to develop expertise in several levels of knowledge, which significantly enhances their effectiveness in performance. This model attempts to focus on the interplay between relationships and their context within the wider system and indicates that a supervisor needs to understand the aspects of each eye during clinical supervision. For the supervision to make successful, both the counselor and supervisor may face issues regarding inappropriate dual relationships as it may increase the potential for exploitation or impairs professional objectivity. Most important ethical consideration in clinical supervision is the informed consent, which is the key to protect the supervisor or counselor from a malpractice lawsuit.

References:

American Psychological Association. (2015). Guidelines for clinical supervision in health service psychology. The American Psychologist, 70(1), 33.

Borders, L. D., Glosoff, H. L., Welfare, L. E., Hays, D. G., DeKruyf, L., Fernando, D. M., & Page, B. (2014). Best practices in clinical supervision: Evolution of a counseling specialty. The Clinical Supervisor, 33(1), 26-44.

Boundary Crossings and Violations in Clinical Settings. (2017). www.ncbi.nlm.nih.gov. Retrieved 24 May 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361837/

Butterworth, T., & Faugier, J. (2013). Clinical supervision and mentorship in nursing. Springer.

Corey, G., Haynes, R. H., Moulton, P., & Muratori, M. (2014). Clinical supervision in the helping professions: A practical guide. John Wiley & Sons.

Daniel, L., Borders, L. D., & Willse, J. (2015). The role of supervisors' and supervisees' mindfulness in clinical supervision. Counselor Education and Supervision, 54(3), 221-232.

Ellis, M. V., Berger, L., Hanus, A. E., Ayala, E. E., Swords, B. A., & Siembor, M. (2014). Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counseling Psychologist, 42(4), 434-472.

Falender, C. A., Burnes, T. R., & Ellis, M. V. (2013). Multicultural clinical supervision and benchmarks: Empirical support informing practice and supervisor training. The Counseling Psychologist, 41(1), 8-27.

Falender, C., Grus, C., McCutcheon, S., Goodyear, R. K., Ellis, M., Doll, B., ... & Kaslow, N. (2016). Guidelines for Clinical Supervision in Health Service Psychology: Evidence and Implementation Strategies.

Farber, B. A., & Hazanov, V. (2014). Informal Sources of Supervision in Clinical Training. Journal of clinical psychology, 70(11), 1062-1072.

Fleming, I., & Steen, L. (Eds.). (2013). Supervision and clinical psychology: Theory, practice and perspectives. Routledge.

Hardy, G. E., Simpson?Southward, C., & Waller, G. (2017). How do we know what makes for “best practice” in clinical supervision for psychological therapists? A content analysis of supervisory models and approaches. Clinical Psychology & Psychotherapy.

Haynes, R., Corey, G., & Moulton, P. (2013). Clinical supervision in the helping professions: A practical guide. Reflective Practice: Formation and Supervision in Ministry, 1.

Inman, A. G., Hutman, H., Pendse, A., Devdas, L., Luu, L., & Ellis, M. V. (2014). Current trends concerning supervisors, supervisees, and clients in clinical supervision. Wiley international handbook of clinical supervision, 61-102.

Jordan, M., Anderson, D., Kennedy, B., & Bagley, J. (2015). The Intergenerational Transmission of Core Values in Clinical Supervision. Journal of Pastoral Care & Counseling, 69(1), 31-33.

Martino, S., Paris, M., Añez, L., Nich, C., Canning-Ball, M., Hunkele, K., ... & Carroll, K. M. (2016). The effectiveness and cost of clinical supervision for motivational interviewing: A randomized controlled trial. Journal of Substance Abuse Treatment, 68, 11-23.

Morgan, S., Ingham, G., Kinsman, L., & Fry, J. (2015). Clinical supervision using random case analysis in general practice training. Education for Primary Care, 26, 34-47.

Morgan, D. L. 2012. “Paradigms lost and pragmatism regained: methodological implications of combining qualitative and quantitative methods”, Journal of Mixed Methods Research, 1(1), pp. 48-76

Onwuegbuzie, A. J. and Leech, N. J. 2012. On becoming a pragmatic researcher: The importance of combining quantitative and qualitative research methodologies. International Journal of Social Research Methodology, 8, 375-387.

Neshuku, H., & Justus, A. H. (2016). Description of an educational programme developed to support registered nurses during clinical supervision of student nurses in medical and surgical wards in a training health facility: Namibia. International Journal of Advanced Nursing Studies, 5(1), 14.

Rousmaniere, T., & Renfro-Michel, E. (Eds.). (2016). Using technology to enhance clinical supervision. John Wiley & Sons.

Scharff, J. S. (Ed.). (2014). Clinical supervision of psychoanalytic psychotherapy. Karnac Books.

Schoenwald, S. K., Mehta, T. G., Frazier, S. L., & Shernoff, E. S. (2013). Clinical supervision in effectiveness and implementation research. Clinical Psychology: Science and Practice, 20(1), 44-59.

Tsong, Y., & Goodyear, R. K. (2014). Assessing supervision’s clinical and multicultural impacts: The Supervision Outcome Scale's psychometric properties. Training and Education in Professional Psychology, 8(3), 189.

Wong, L. C., Wong, P. T., & Ishiyama, F. I. (2013). What helps and what hinders in cross-cultural clinical supervision: A critical incident study. The Counseling Psychologist, 41(1), 66-85.