Academic journal article Australian Health Review

Effective Clinical Supervision for Regional Allied Health Professionals - the Supervisee's Perspective

Academic journal article Australian Health Review

Effective Clinical Supervision for Regional Allied Health Professionals - the Supervisee's Perspective

Article excerpt

Introduction

Clinical supervision (CS) has become part of standard practice for health professionals, based on perceived benefits to the clinician, the patient and the organisation. The large regional health service where the current study was conducted consists of 200 acute, 60 subacute and 500 residential aged care beds, plus community based programs, and employs 120 allied health professionals (AHPs). There is a strong organisational commitment to the provision of CS for all health professionals, however, the experience, understanding of, and existing skills in CS differ across the allied health disciplines, with CS tending to be more embedded into the clinical practice of social workers and psychologists. This discipline focus is echoed in the literature, with limited reports of research into CS for other allied health professionals (AHPs). Evaluation of the effectiveness of CS is important, as CS demands commitment of resources and time. It has been suggested that poor or ineffective CS may detrimentally affect staff, including job dissatisfaction and concerns with confidentiality within CS.1-3

Defining clinical supervision

There is not an all-encompassing definition of CS,4-6 with previous definitions of CS identifying a process which addresses the development of clinical skill, knowledge, support and self growth through reflective practice. Kavanagh et al. definedCSas:

a working alliance between practitioners in which they aim to enhance clinical practice, fulfil the goals of the employing organisation and the profession and meet ethical, professional and best practice standards of the organisation and the profession, while providing personal support and encouragement in relation to the professional practice (p. 247).5

This definition places CS as important not only for the individual, but also for the employing organisation and for the provision of best practice patient care. More recently, CS has been recognised as being a critical component of a comprehensive clinical governance framework.7 Clinical governance is defined as 'the system by which the governing body, managers, clinicians and staffshare responsibility and accountability for the quality of care, continuously improving, minimising risks and fostering an environment of excellence in care for consumers/patients/residents' (p. 4).8 Clinical supervision is an important clinical governance strategy which ensures accountability, practitioner competency and patient safety.

Several models of CS have been reported, with Proctor's model of CS cited frequently by authors in the United Kingdom.9 Proctor's model proposes that CS should fulfil three main areas: restorative, formative and normative.9,10 The restorative area is the supportive component of supervision, where the supervisor hears work distress, checks for burnout and directs to appropriate help. The formative area of supervision includes critically examining the supervisee's interactions with their clients and their clinical interventions, addressing skill development and embedding evidence-based practice. Finally, the normative area deals with professional issues of boundaries, confidentiality, codes of practice or ethics, and quality.9,10 Proctor's model of CS has been reported to have face validity; however, its theory development was not empirically based and the model itself provides no guidance to supervisors on what to offer for particular components of the theory.11 It could also be argued that CS models which guide practice should not be too prescriptive, but act as a framework that is underpinned by principles, and Proctor's theory makes this contribution.6 Proctor's model broadly defines components or functions of CS and is easily applied where diversity of experience, skills and level of training and professional background of both supervisor and supervisee exists.

The CLEAR (or integrative) model describes the tasks or processes of supervision as contract, listen, explore, action and review. …

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