Group clinical supervision for nurses: process, group cohesion and facilitator effect

Abstract

Objective: This qualitative research project set out to explore how, and by what means, participation in group clinical supervision might impact nurses. It aimed to describe participant perceptions of the processes within a long running reflective practice group for intensive care nurses and explore these in relation to relevant theory. Background: Interpersonal aspects of care are central to the nursing role, however, the associated emotional labour can develop into moral distress, compassion fatigue and burnout. Australia’s peak nursing and midwifery bodies have released a joint position statement on the importance of supervision for nurses. Group supervision interventions, such as reflective practice groups, mitigate stress, promote learning and support interpersonal aspects of nursing. Method: Twenty-two intensive care nurses from a reflective practice group that had been running for 10 years, participated in focus groups convened by an independent researcher. Thematic analysis identified key perceptions relating to process and outcomes. Results: Group identification, voluntary participation and skilled facilitation created an enabling environment for nurses to self-disclose. The sense of universality experienced by participants, along with increased empathy, enabled reflection and self-evaluation relevant to the group prototype of the ideal nurse. Authentic emotional expression was seen to provide respite from emotional labour, thereby regenerating resources for nurses to cope with job demands. Discussion: Key themes can be aligned to social psychology constructs of group identity, task interdependence and homogeneity, supporting earlier studies that suggest group cohesion is comprised of measurable factors. By developing and aligning with these constructs, the facilitator assists the group to establish a safe space whilst conceptualizing and aspiring to a model for the professional and compassionate nurse. Conclusion: Social psychology constructs can help develop practice and research of group supervision for nurses. In clinical nursing settings, group identity is particularly salient and facilitator interventions should aim to strengthen this. The development of a sense of universality, when combined with voluntary participation and a focus on intra-group process, can enhance cohesion and create a safe space for self-disclosure. This enables nurses to examine actions and responses to clinical situations and explore emotions incongruent with the ideal nurse prototype, thereby promoting restorative and formative benefits. Implications for research, policy, and practice: This study adds to our understanding of processes in group clinical supervision for nurses and suggests that it is appropriate to apply social identity theory to improve practice and research. It will be of interest to nurses and nursing leaders who wish to develop supervision programs. What is already known about this topic? Compassion fatigue, emotional labour and moral distress contribute to nurse burnout. Group Clinical Supervision can help mitigate stress, enhance learning and support interpersonal aspects of nursing care. The supervisory alliance is an important factor in effective clinical supervision whilst group cohesion is an important factor in the effectiveness of group work. What this paper adds: Reflective Practice Groups (RPG) are defined as a form of Group Clinical Supervision that utilize social support as a resource. RPG facilitation principles are aligned with social psychology constructs of group identity, task interdependence and homogeneity. Alliance with the facilitator and cohesion within the group, enhanced by voluntary participation and facilitation techniques, allow group members to access restorative and formative benefits whilst prompting self-evaluation against the group ideal nursing prototype.