Clinical Supervision and Positive Practice Environments in Healthcare: a scoping review

The purpose of this systematic review is to gather and analyze data from existing research on the effects of clinical supervision (CS) intervention on nurses' job satisfaction and related outcomes such as stress levels, burnout, and care quality. Using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) criteria, a systematic review of the research available in the databases PubMed, PsycInfo, Cochrane Library, and CINAHL, well as Google Scholar, between January 2010 and May 2023 was carried out. Out of the 760 studies assessed, only 8 met the criteria for inclusion in the review based on Hawker's assessment tool. The results indicate that CS has a positive impact on nurses' job satisfaction and related outcomes such as reduced burnout, stress levels, and the quality of care. The study also found that the effectiveness of CS in enhancing job satisfaction was most evident during the 6-month follow-up period. However, nurses who did not receive CS did not show any noticeable improvement in their knowledge or practice. Additionally, nurses who required more efficient clinical oversight reported little to no positive impact on their practice or training. The review also highlighted gaps in knowledge regarding the frequency and number of sessions required for the impact of CS on nurses' job satisfaction and other outcomes. Due to the limited number of studies included in this review, further research is recommended to evaluate the influence of CS on nurses' job satisfaction.

AimsThe aim of this review is to identify and map the evidence available on the factors that influence the implementation of clinical supervision for nurses.DesignThe scoping review was conducted and reported following the JBI methodology for scoping reviews.Data SourcesSearches were conducted on MEDLINE, PsycINFO, and CINAHL databases on 28 March 2023.Review MethodsA total of 1398 studies were imported into Covidence for screening. Researchers screened the papers according to the inclusion criteria. Empirical studies in English focusing on the implementation of clinical supervision for nurses were included, without year restrictions. Data from 16 studies were extracted and organized according to the constructs within the Consolidated Framework for Implementation Research (CFIR) domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process.ResultsWhen compared with the CFIR constructs, it was found that the influence of the outer setting on implementation was less explored in the literature. Most of the reviewed data highlighted recurring factors, particularly logistical challenges of nursing work such as shift work and lack of control over work time. Organizational culture and managerial support were also identified as significant factors in the implementation. Another significant challenge in implementation was the variety in clinical supervision's design, purpose, and application, despite sharing the same label, leading to questions about whether studies are implementing the same practice.ConclusionPolicy documents should clearly define both the design and purpose of clinical supervision, beyond just its conceptual definition. Greater emphasis on equitable implementation of clinical supervision is necessary to prevent perpetuating existing inequalities. We conclude that implementation of such complex interventions is not linear, and the implementation strategies need to align with expected implementation challenges.ImpactThe advantage of using the implementation framework lies not only in observing what exists as a form of evidence but also in identifying what is underdeveloped. Healthcare services and policy developers can utilize our review to recognize and address potential challenges in introducing, modifying, scaling up, or sustaining their clinical supervision implementation.Patient or Public ContributionNo patient or public contribution.

Limited literature exists on the practice of clinical supervision (CS) of professional physiotherapists despite current Australian safety and quality health standards stating that CS is to be provided to all physiotherapists. The aim of the present study was to evaluate the effectiveness of CS of physiotherapists working in an Australian public health service. CS was measured using the allied health-specific 26-item modified Manchester Clinical Supervision Scale (MCSS-26). Subscales of the MCSS-26 were summed for three domain scores (normative, restorative and formative) and a total score was calculated, which was compared with the reported threshold score of 73 for effective supervision. Sixty registered physiotherapists (response rate 92%), working for a large metropolitan public health service, with six different site locations, completed the survey. The mean (± s.d.) total MCSS-26 score was 71.0 ± 14.3 (95% confidence interval (CI) 67.4-74.6). Hospital site was the only variable that had a significant effect on total MCSS-26 score (P=0.005); there was no effect for supervisor or supervisee experience, or hospital setting (acute vs subacute). Physiotherapists scored a significantly lower mean percentage MCSS-26 score on the normative domain compared with the restorative domain (mean difference 7.8%; 95% CI 2.9-12.7; P=0.002) and the formative domain (mean difference 9.6%; 95% CI 6.3-13.0; P<0.001). Of the two subscales that form the normative domain, 'finding time' had a significantly lower mean percentage MCSS-26 score than 'importance/value of CS' (mean difference 35.4%; 95% CI 31.3-39.4; P<0.001). Within this publicly funded physiotherapy department there was uncertainty about the effectiveness of CS, with more than half the physiotherapists rating their supervision as less than effective, suggesting there is opportunity for improvement in the practice of physiotherapy CS. Physiotherapists scored lowest in the normative domain, indicating that they found it difficult to find time for CS.

Patient engagement with psychological safety

ABSTRACTAimTo understand the extent and type of evidence that exists related to nurses' and midwives' experiences of participating in clinical supervision and ascertain how clinical supervision is defined in the literature.DesignA scoping review of peer reviewed research.Data SourcesCINAHL Complete (EBSCOhost), MEDLINE (Ovid), PsycINFO (EBSCO), Embase (Elsevier) and the Cochrane Library were searched for relevant articles published between 2010 and 2024.Review MethodsThe scoping review followed the JBI methodology.Reporting MethodPRISMA‐ScR.ResultsForty‐three articles were included, qualitative, quantitative, mixed methods studies and three reviews were found describing nurses' and midwives' experiences of clinical supervision. The studies identified were carried out across 15 countries and reported on experiences of group clinical supervision, one to one clinical supervision or both, more recent studies included a focus on group clinical supervision. All definitions found are reported, and although these varied, there were frequently used terms common in many.ConclusionAlthough some evidence exists on how nurses and midwives experience clinical supervision gaps in evidence and detail of supervision practices remain. Inconsistencies of approach to this practice remain and specific detail relating to clinical supervision explored in existing research is frequently lacking. The lack of a universally accepted definition highlighted may influence inconsistences in clinical supervision, key terms identified in this review may assist in the development of a definition. Further research into this support is required to establish its value in practice.ImpactThis scoping review progresses the ongoing debate that clinical supervision is a valuable support for nurses' and midwives' but the absence of evidence is an indication that clinical supervision is not fully understood nor is visible in practice. To this end, this review highlights that the lack of consensus on a clinical supervision definition causes ambiguity thus reducing the use of this support for nurses and midwives.Patient or Public ContributionThere was no patient or public contribution to this paper as it is a review paper that seeks information on research available on a professional support.Protocol registration@ Open science Framework: identifier 10.17605/OSF.IO/QNKUR

Purpose: This scoping review aimed to identify application methods, effectiveness, facilitating factors, and obstacles to clinical supervision for nurses in maternal and child health and to understand its discriminatory characteristics compared to mentoring.Methods: This study was based on the scoping review methodology and consisted of six stages: (1) identifying research questions; (2) identifying relevant studies (search strategy); (3) study selection; (4) charting of the data; (5) collating, summarizing, and reporting the results; and (6) consultation. From April to July 2022, 1,323 studies were searched in PubMed, CINAHL, Cochrane, and Open Gray, and finally eleven studies were selected through the literature selection process.Results: Because clinical supervision aimed to strengthen the professional capabilities of nurses, reflective practice was applied. However, mentoring was designed to acquire knowledge or skills that can be applied directly in practice. Therefore, indicators to measure the effects of clinical supervision consisted of psychosocial factors, such as job satisfaction and exhaustion, but the effects of mentoring were evaluated primarily using knowledge levels and skills. The model, which is applied mainly in clinical supervision, reflects the restorative function. When applying clinical supervision and mentoring, listening, supportive environment, and accessibility were identified as facilitating factors, while criticism, lack of time and space, and excessive workload were identified as obstacles.Conclusions: Time and space must be secured to provide effective clinical supervision. The confidentiality of the supervisee must be guaranteed, and sufficient information must be provided in advance so that nurses can accurately recognize the clinical supervision process. Finally, a policy for institutionalizing clinical supervision should be supported to ensure its applicability and sustainability.

This study aims to review and synthesize the empirical evidence about the connection between healthcare facility design and the mental health of healthcare professionals by reviewing the relevant literature. Mental exhaustion of healthcare professionals is becoming a critical issue in healthcare, especially during the pandemic. The physical design of healthcare facilities has significant potential to reduce and prevent the mental exhaustion of healthcare professionals by removing environmental stressors and providing restorative experiences. However, the built environment is not fully utilized as an intervention to support healthcare professionals. Relevant articles were identified from the Medline, PsycINFO, PubMed, and Web of Science databases using a combination of search terms representing environmental design factors and health outcomes. Identified articles were reviewed by their titles, abstracts, and full texts using the inclusion and exclusion criteria. The search yielded 27 empirical articles investigating the relationships between environmental design factors and staff mental health outcomes, including stress, fatigue, job satisfaction, burnout, and well-being. Healthcare design aspects that were investigated in the identified articles include overall facility and perception (e.g., aesthetic appeal and impression, belonging to the surroundings, safety), specific spaces (e.g., patient area, staff workspace), intangible elements (e.g., exterior view, light, sound), and interior space and ergonomics (e.g., material finishes, furniture). Through the synthesis of the current literature regarding the relationships between healthcare facility design and the mental health of healthcare professionals, this study provides implications for supporting healthcare professionals through the design of the healthcare facility.

Background: Job satisfaction remains a persistent concern in care facilities, where frontline caregivers work in highly relational and emotionally demanding environments. Although both personality traits and psychological safety have been associated with job satisfaction, their relative contributions and potential interrelationships in routine care settings remain unclear. Methods: Drawing on organizational and psychological theory, we hypothesized a priori that personality traits, psychological safety, and job satisfaction would be statistically associated, with psychological safety mediating the relationship between personality traits and job satisfaction. A cross-sectional questionnaire survey was conducted in care facilities, and the final analytical sample consisted of 183 frontline caregivers selected according to predefined inclusion criteria. Structural equation modeling (SEM) was used to test the hypothesized mediation model. Group comparison analyses examined differences in psychological safety across levels of job satisfaction. In addition, machine learning models were applied to explore predictive patterns among personality traits, psychological safety, and job satisfaction. Results: In the SEM analyses, psychological safety was significantly associated with job satisfaction ( = 0.207, p < 0.05), although the effect size was modest. Personality traits did not show direct associations with job satisfaction. Instead, agreeableness ( = 0.232, p < 0.01) and neuroticism ( = −0.235, p < 0.01) were associated with psychological safety, which, in turn, was related to job satisfaction. Bootstrap resampling supported the presence of significant indirect associations. At the item level, communication-related aspects of psychological safety were particularly salient. Caregivers with different levels of job satisfaction differed most clearly in communication-related items. Consistent with this pattern, exploratory machine learning analyses (XGBoost) also identified psychological safety as a more important predictor of job satisfaction than personality traits. Conclusions: These findings suggest that, among frontline caregivers working in healthcare facilities, psychological safety was more closely associated with job satisfaction than individual personality traits. In particular, the ability to speak openly and raise concerns was more strongly associated with higher levels of job satisfaction within this care context. Personality traits were associated with job satisfaction primarily through their relationship with psychological safety rather than through direct associations.

ABSTRACTClinical supervision is a psychologically safe practice that aims to provide support and training for workers within the healthcare industry, including mental health nurses. Over the years, clinical supervision has been cited as a practice to improve workforce outcomes for both individual mental health nurses and the organisations they work in. The aim of this scoping review is to examine the evidence exploring the relationship between clinical supervision and workforce outcomes for mental health nurses. Twenty‐eight articles sourced from six databases were included in this study. The most frequently evaluated workforce outcomes were competence (n = 14), workplace culture (n = 13) and compassion (n = 7). Studies reported that the association between clinical supervision and workforce outcomes was predominantly positive, but there were mixed results for competence, workplace culture, job satisfaction and burnout. Details on the type of clinical supervision received by participants were limited, and most of the evidence included in this review included qualitative research and participants self‐reporting their perceived benefits from clinical supervision, as opposed to using validated instruments in experimental and/or longitudinal study designs. Organisations should be hesitant to implement mandatory clinical supervision within workplaces, as this could have the opposite effect on workforce outcomes for mental health nurses who are already time‐poor and overworked, as well as those who are indifferent or hostile to clinical supervision.

Introduction The National Training Survey (NTS) is conducted annually by the General Medical Council (GMC) to monitor and report on the quality of postgraduate medical education and training. The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on training in cardiothoracic surgery due to the unprecedented restructuring of surgical activity across the UK. We aim to evaluate how the job satisfaction of cardiothoracic surgery trainees was impacted by COVID-19 using the National Training Survey. Methods The National Training Survey in cardiothoracic surgery from 2017 to 2024 was obtained from the General Medical Council website. Job satisfaction for trainees was evaluated using 17 indicators: Adequate Experience, Clinical Supervision, Clinical Supervision Out of Hours, Educational Governance, Educational Supervision, Feedback, Handover, Induction, Local Teaching, Overall Satisfaction, Regional Teaching, Reporting Systems, Rota Design, Study Leave, Supportive Environment, Teamwork and Workload. The pre-pandemic score for each indicator was an average of 2017, 2018 and 2019, while the post-pandemic score was an average of 2022, 2023 and 2024. The overall job satisfaction per year, combining all indicators, was also analysed. Results Thirty-eight cardiothoracic centres were included in this study. There was a reduction in trainees' job satisfaction from pre- to post-pandemic surveys when comparing all 17 indicators together (scored out of 100) (73.87 versus 70.97, p<0.001). There were six out of 17 (35.29%) indicators that demonstrated a significant decrease in job satisfaction amongst trainees: Regional Teaching (70.53 versus 54.53, p<0.001), Adequate Experience (78.65 versus 72.34, p=0.003), Local Teaching (68.26 versus 62.92, p=0.037), Educational Governance (73.78 versus 70.36, p=0.033), Clinical Supervision Out of Hours (91.16 versus 87.95, p=0.005) and Clinical Supervision (91.98 versus 88.92, p=0.014). Conclusion Trainees' job satisfaction significantly decreased after the COVID-19 pandemic. Although the most recent survey suggests job satisfaction amongst trainees may be recovering, further work needs to be done to ensure training standards return to pre-pandemic levels.

School heads’ clinical supervision practices and emerging teacher emotions in Tanzania secondary schools

After decades of discussion about clinical supervision and mental health nursing, the reality is that many acute mental health inpatient settings continue to struggle with the notion of clinical supervision and the implementation process. In this article we delineate the key elements of clinical supervision, explore practical and dynamic difficulties associated with clinical supervision and question whether too much is being asked of this one process, especially in acute inpatient settings. For many mental health nurses, existing practices offer many of the purported benefits of clinical supervision. Ultimately, unless clinical supervision is better understood and implemented effectively, it is unlikely to meet expectations. Clinical supervision should ultimately be defined by the nurses participating in it. This article contributes to current discussions regarding the purpose of clinical supervision, the realities of its implementation, and in particular considers the role of clinical supervision relative to existing professional support opportunities.

Achieving Excellence in Nursing Management

Clinical supervision and resilience in nurses: A scoping review.

British Journal of NursingVol. 4, No. 15 EditorialDefining and setting the parameters of clinical supervisionAndy FarringtonAndy FarringtonSearch for more papers by this authorAndy FarringtonPublished Online:26 Aug 2014https://doi.org/10.12968/bjon.1995.4.15.874AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail FiguresReferencesRelatedDetailsCited byA rationale for a clinical supervision database for mental health nursing in the UK5 March 2012 | Journal of Psychiatric and Mental Health Nursing, Vol. 19, No. 5The Integration of Clinical and Managerial Supervision: A Critical Literature Review1 January 2008 | British Journal of Occupational Therapy, Vol. 71, No. 1Clinical supervision: what do we know and what do we need to know? A review and commentaryJournal of Nursing Management, Vol. 14, No. 8Efficacy of clinical supervision: influence on job satisfaction, burnout and quality of careJournal of Advanced Nursing, Vol. 55, No. 4Clinical supervision: beginning the supervisory relationshipGraham Sloan27 September 2013 | British Journal of Nursing, Vol. 14, No. 17POSTMODERNISING CLINICAL SUPERVISION IN NURSING9 July 2009 | Issues in Mental Health Nursing, Vol. 26, No. 5An audit of clinical supervision in primary careLouise Barriball, Alison While, Ulrike Münch27 September 2013 | British Journal of Community Nursing, Vol. 9, No. 9Peer supervision: an experimental scheme for nurse lecturersNurse Education Today, Vol. 23, No. 1Egalitarian consultation meetings: an alternative to received wisdom about clinical supervision in psychiatric nursing practiceJournal of Psychiatric and Mental Health Nursing, Vol. 7, No. 6Clinical supervision and managerial supervision: some historical and conceptual considerationsJournal of Advanced Nursing, Vol. 30, No. 5Good characteristics of a clinical supervisor: a community mental health nurse perspective25 December 2001 | Journal of Advanced Nursing, Vol. 30, No. 3Staff Supervision for Occupational Therapists5 November 2016 | British Journal of Occupational Therapy, Vol. 62, No. 8Getting the most from clinical supervision. Part one: the superviseeMental Health Practice, Vol. 2, No. 6'Out of the sighs'- an existential-phenomenological method of clinical supervision: the contribution to palliative careJournal of Advanced Nursing, Vol. 27, No. 5Reflection and the management of community nursing practiceJohn Driscoll27 September 2013 | British Journal of Community Health Nursing, Vol. 1, No. 2 10 August 1995Volume 4Issue 15ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 26 August 2014 Published in print 10 August 1995 Information© MA Healthcare LimitedPDF download