Supervision Practices Research Articles

The Principle of Cost-Based Supervision in Practice

A key response of financial regulators around the world to the financial and economic crises of ten years ago has been the formation of supervisory committees. Such committees now exist in several countries worldwide. Consequently, many regulators fund their supervisory function by charging their supervisees. The objective of this paper is to compare how these regulators charge fees, identify common practices, draw conclusion from observations, and provide relevant recommendations. This paper especially focuses on the Federal Reserve, the European Central Bank and the Bank of England that charge fees just enough to recover the cost of supervisory function, or those that follow what this paper refers to as the “principle of cost-based supervision.” A discussion on how selected examples of regulators practice the principle of cost-based supervision follows. Simulations of fees using selected procedures to supervisees in the Czech Republic and Greece follow. Then this paper introduces the asset elasticity of cost notated as n and simulates the hypothetical supervisory fee if n is constant.

A Qualitative Study of School Mental Health Providers’ Experiences with Chart Notes: Perceived Utility, Burden, and Areas for Growth

ABSTRACT Background Despite the ubiquity of chart notes and their well-known impact on medical providers’ job stress and satisfaction, little is known about how mental health providers interact with and are impacted by documentation requirements, particularly in school environments. Objective This qualitative study sought to investigate school mental health providers’ perspectives on and experiences with documentation. Method Four focus groups with eight school mental health providers were conducted. Providers were asked about their current documentation practices and desired changes to their electronic health record system. Recordings of focus groups were transcribed and analyzed for themes using a rapid qualitative analytic approach. Results Key themes revolved around the purpose, features, time demands, training needs, and writing processes surrounding chart notes. Providers reported spending substantial time and energy on documentation and viewed chart notes primarily as a billing requirement, but also valued their utility for treatment planning, outcome monitoring, and clinical accountability. Providers expressed frustration with redundant data entry, lack of protected time for documentation, insufficient training for and communication around updates to documentation requirements, and strained interactions with supervisors during editing. Providers highlighted scheduling protected work time for documentation, enhancing documentation training with a focus on habit formation, standardizing supervisory expectations and providing documentation specific training for supervisors, and redesigning electronic health record interfaces with automation and checklists as strategies that could improve their experiences with chart notes. Conclusions Providers highlighted the ways current training and supervision practices, time constraints, and electronic health record functionality contribute to job stress and burnout while also noting the value of documentation for treatment planning and processing difficult emotions. Roadmaps outlining further research that is needed to understand these suggestions from providers in the larger context of clinical documentation, as well their potential benefits and tradeoffs for providers and other stakeholders, are discussed.

Finally, a Researcher Development and Education Skills Framework for an Open University

While there is an ongoing advocacy for transformative higher education through a collaborative research culture in a national university system (Almores, 2024; Cubillan, 2024), there lacks an explicit and unified framework for researcher development of valuable skills and competencies to inform its typology of research training, supervision and mentoring (Villanueva, 2024). We propose a researcher development and education framework to benefit open and distance elearning programs, or ODeL programs situated in the national university’s Open University constituent unit with a wide reach of students locally and in Southeast Asia (Alfonso, 2019). The framework is a by-product of our sustained intellectual and intertextual networking, engagements with an international network of researchers in doctoral education and consultations with teacher-researchers and other stakeholders in an open university. The framework is underpinned by the identity-trajectory theory, self-determination theory and the community of inquiry for learning community building in harnessing positive research student experiences (Villanueva & Eacersall, 2024). Key areas of the framework are namely, research as a personal and scholarly practice, a reflective practice, a collaborative practice and a technology-enabled practice. Surrounding these key areas are shared values of: (i) excellence, rigor and creativity; (ii) agency and wellbeing; (iii) sense of community, social responsibility and service to others; and, (iv) integrity, agency and future-ready. Further validation of the framework was conducted through focused group discussions across three faculties of study. Collaborative reflections among faculty members and research students were undertaken to further define specific research competencies as well as mindsets. A natural outcome was the conceptualization of three courses pilot-test the application of the framework in varied learning spaces for a range of learners within the Open University unit. MyPORTAL Course 1 is a formal course for graduate-level students crafting their personalized learning plans for selected research-related outputs while ASCEND Course 2 is non-formal short course for professional research staff and students to navigate their academic writing and research with the use of Generative AIs. WORKSPACE Course 3 is a self-paced micro-course as an opportunity for faculty members to spend dedicated sensemaking on current practices in mentoring and research supervision. These courses are meant to operationalize intentional learning alliance and community building to harness researcher identity development and sense of agency among research students in ODeL programs. Further research is recommended in launching these courses and towards the creation of graduate research support teams with researcher development specialists and volunteer research trainers and learning designers. The teams are meant to go beyond administerial functions to ensure exemplary pedagogy and practices, benefiting both research supervisors and their students. The study all the more highlights the Open University’s unique identity as a progressive driver of innovation and within a dominant residential-based university system’s seeking to translate the transformative education rhetoric into actual practice at the program and course levels. Finally, we lay our claim of an ODeL research culture that is truly open, collaborative and future-ready.

Supervision of the Performance of Education Personnel as an Effort to Realize Quality Education Service Standards

This study aims to evaluate the effectiveness of supervision of the performance of education personnel at SMP Negeri 11 Palembang by comparing the implementation of activities with the standards that have been set. Supervision in the context of education is known as supervision, where school supervisors have an important role in coaching and assessment both in academic and managerial aspects. In this study, the researcher uses a qualitative descriptive method with data collection techniques through observation, interviews, and documentation. The research respondents included the Principal, Vice Principal, Administrative Staff, and Head of Library. Data analysis was carried out by data reduction techniques, data presentation, and conclusion drawn, and data validity tests using source triangulation and techniques. The results of the study show that supervision is carried out regularly and systematically, with a focus on timeliness, quality, quantity, and cooperation of education personnel. The principal directly monitors and compares the work results with the set standards, as well as provides feedback for performance improvement. The findings of the study reveal that the measurement of the implementation of activities plays an important role in maintaining the quality of performance, improving discipline, and creating a professional work culture. Supervision that is carried out well not only functions as an evaluation tool, but also as a means to increase the motivation and competence of education personnel. This study recommends that the supervision and measurement practices applied at SMP Negeri 11 Palembang can be adopted by other schools to improve the overall quality of education.

Expansion of Remote Supervision Technology in Community Corrections: Lessons Learned from One State During COVID-19

ABSTRACT The COVID-19 pandemic substantially disrupted community corrections work and forced agencies to adapt to continue maintaining public safety and helping clients navigate supervision. During this time, technology emerged as a key innovation to allow agencies to continue to achieve these mandates. The current study sought to better understand the role of technology in supervision during the pandemic with an emphasis on front-line officer perceptions. Using surveys of 184 probation and parole officers, we examined how officers adapted their supervision approach, the role of technology in this process, and the use of a mobile application to continue supervision during the pandemic. Study findings highlight pragmatic, risk-based adaptations that were made to supervision practices and ways technology was leveraged to mitigate the burdens of the pandemic. Additionally, we identified a number of barriers that hindered innovative efforts. This study adds to a growing discussion surrounding the promise of technological innovation in community corrections and how community corrections agencies can proactively prepare for future disruptions.

Impact of nurse education prior to and during COVID-19 on nursing students’ preparedness for clinical placement: a qualitative study

Introduction: Nursing students internationally entered challenging clinical placements during COVID-19. Lessons learnt could inform nurse education planning, particularly in preparation to implement future workforce plans.Aim: This study aimed to explore the impact of COVID-19 on nursing students undertaking clinical placements across the UK, particularly the extent to which nursing education prior to and during COVID-19 had prepared them for placements, and to distil key messages for future nursing education.Methods: A UK-wide qualitative study was conducted using audio or written placement diaries and post-placement telephone or online interviews with nursing students from all years of study and from adult, children, mental health and learning disability disciplines. Transcripts were analysed thematically using the Framework Approach. A pre-survey collected participants’ demographic information, details and expectations of their upcoming clinical placements, and how well prepared they felt. Ethical approval was gained.Results: Two hundred and sixteen nursing students from across the UK participated in the study. Five key themes were identified: ‘stepping up to the challenge and feeling the fear’, ‘new ways of learning’, ‘theory versus clinical practice’, ‘impact on clinical and academic partnerships’, and ‘concerns around demonstrating proficiency’.Discussion: Differing levels of preparedness of nursing students for clinical placement were reported. While many felt honoured to be a part of the nursing workforce during COVID-19, the rapidly changing clinical landscape led to unplanned changes to placements, lack of skills practice, uncertain practice supervision and distance learning which impacted on their confidence and perceived levels of competence leading to anxiety around demonstrating proficiency and achieving practice hours. Greater collaboration between universities, clinical placement teams, policy makers and regulators are key lessons post COVID19 to improve the support and preparedness of nursing students.

Analysis of implementation science strategies to train laparoscopic surgical skills among Liberian surgeons using ALL-SAFE.

Significant disparities exist in laparoscopic training opportunities for surgeons in low- and middle-income countries (LMICs). ALL-SAFE is an innovative, low-cost training system for LMIC surgeons' laparoscopic development. However, strategies to implement and scale ALL-SAFE are unstudied. We aimed to assess the impact of implementation science strategies on ALL-SAFE uptake in Liberia, a novel and low-resource context. This study used implementation science approaches to evaluate ALL-SAFE uptake in three Liberian hospitals: John F. Kennedy Medical Center, Phebe, and ELWA. Five validated implementation strategies of program orientation, local champions, network weaving, feedback mechanisms, and practical supervision were piloted. All five strategies were implemented at two hospitals, while four strategies, excluding clinician supervision, were implemented at the final site as a pseudo-control, to evaluate the impact of resource-intensive supervision. Participants included surgical consultants, residents, and medical students. Engagement was assessed with mixed methods including participant number, practice hours, module completion rates, and strategy feasibility through end-user interviews. Across three hospitals, 33 participants used ALL-SAFE for 87.8 total training hours (5,268min). Participant numbers varied across sites (NJFK = 20, 80%; NPhebe = 7, 88%; NELWA = 6, 86%), as did practice times (TotalJFK = 3,060min, Median time/ParticipantJFK = 103min; TotalPhebe = 1,434min, Median time/ParticipantPhebe = 126min; TotalELWA = 774min, Median time/ParticipantELWA = 100min). Sites with practical supervision demonstrated higher engagement than those without (P = 0.042). Interviews (n = 8) revealed positive perceptions toward program orientation, practical supervision, and network weaving. Participants recommended thirteen additional strategies for sustainability including translating ALL-SAFE skills to patient care. Our study is one of the first to evaluate implementation science strategies for laparoscopic training in sub-Saharan Africa. The implementation bundles of five validated strategies were considered feasible by Liberian surgeons in both urban and rural hospitals. Mixed methods suggested a positive association between engagement and the resource-intensive practical supervision strategy. Future studies should focus on quantifying individual strategy contributions with rigorous implementation designs and assessing sustainability strategies.

Clinical supervision effectiveness in NHS nursing, medical and allied health professionals: Exploring interaction with workplace factors, supervision factors and burnout.

The study aimed to (1) determine if a variety of workplace and supervision factors predict clinical supervision effectiveness; and (2) establish if clinical supervision effectiveness predicts burnout, amongst a variety of mental health staff (medical, allied health, and nursing staff). The study adopted a multicentre cross-sectional online survey design. Participants included 204 mental health staff (89 allied health staff, 81 nursing staff, and 34 medical staff). The Manchester Clinical Supervision Scale (MCSS-26) was used to measure clinical supervision effectiveness, and the Maslach Burnout Inventory (MBI-HSS) was used to measure burnout. Linear regression analyses and multiple regression analyses were conducted. The main findings suggested that supervision frequency, supervision duration, choice of supervisor, workplace setting, and supervisee profession, were all significant predictors of clinical supervision effectiveness. Additionally, clinical supervision effectiveness was a significant negative predictor of burnout. Workplace and supervision factors should be considered in supervision practice across professional groups. Policies need to promote effective clinical supervision practice.

Digital supervision in the clinical learning environment: Characterizing teamwork in the electronic health record.

Attending physicians in academic hospitals work in supervisory team structures with medical residents to provide patient care. How attendings utilize the electronic health record (EHR) to support learning through supervision is not well understood. To compare EHR behavior on teaching versus direct care, including evidence of supervisory calibration to learners. Cross-sectional study analysis of EHR metadata from 1721 shifts of hospital medicine faculty at a large, urban academic medical center, January to June 2022. Measures included total EHR time per shift, EHR time outside shift, and time spent on: note-writing, note review/attestation, order entry, and other clinical review. We assessed within physician differences across these service types and used multilevel modeling to determine whether these behaviors varied with resident physicians' experience, accounting for physician-specific signature behavior patterns. Attendings spent substantially less time in the EHR while on teaching service than on direct service (129 vs. 240 min; p < .001) and apportioned their work differently throughout the day. Physicians were less behaviorally consistent and varied more than their peers when on teaching service. Attendings calibrated their supervision to learners. Attendings logged 12.7% less EHR time when paired with more senior residents than postgraduate year 2 (PGY2) residents (137 vs. 120 min, p = .002). PGY1 presence was also associated with reduced EHR time, suggesting some delegation of supervision to senior trainees. EHR behaviors on teaching service are highly variable and differ substantially from direct care; a lack of consistency suggests important opportunities to establish best practices for EHR-based supervision and create an effective clinical learning environment.

Social Auxiliary Workers as the “Cinderellas” of Supervision: The Case of John Taolo Gaetsewe District, Northern Cape Province

The supervision of social auxiliary workers has received little attention, both in research and supervision practice. Social auxiliary workers are trained and qualified to support the services of qualified social workers. Yet, despite their importance in social welfare service delivery, social auxiliary workers are seen as the stepchild to social workers and are often neglected in terms of receiving supervision for their professional duties. This article explores how social auxiliary workers experience supervision to guide their daily activities. Although there are a few studies on the supervision experiences of social auxiliary workers in South Africa, there are no previous studies focused on the Northern Cape province. This article is based on a qualitative study that used an exploratory and descriptive research design. Semi-structured interviews were used to gather data from six social auxiliary workers in the John Taolo Gaetsewe District of the Northern Cape. Using Tesch’s eight steps of analysis, the findings reveal the inconsistent use of the role and function of supervision in developing the capacity and training of social auxiliary workers and the implications of ineffective supervision. A key recommendation is that social auxiliary workers should have mandatory, structured and supportive supervision to uphold the professional purpose of employing social auxiliary workers in the context of social service delivery to vulnerable populations.

The supervisory relationship as a predictor of mental health outcomes in doctoral students in the United Kingdom.

The process of a doctorate degree has been implicated in the onset and exacerbation of mental health problems among doctoral students. Previous studies have suggested that the student-supervisor relationship may predict emotional wellbeing and mental health outcomes in doctoral students in the UK. However, these studies were conducted before the COVID-19 pandemic and often used unstandardized measures to investigate supervisory styles. The present study was part of the Better Together project, a wellbeing initiative for doctoral students in the UK. It explored the predictive ability of aspects of the student-supervisor relationship with regards to doctoral students' mental health outcomes. The sample consisted of 141 students doing a research-based doctorate degree in the UK. The survey included demographic questions and questionnaires assessing supervisory styles, the discrepancy between actual and preferred supervisory relationship, depression, anxiety, and stress. A large proportion of participants fell in the severe and extremely severe categories in the depression, anxiety, and stress sub-scales. Multiple regression analyses indicated that both supervisory styles and discrepancy significantly predicted students' mental health outcomes. More specifically, higher scores in the uncertain supervisory style, which is characterized by indecisiveness and ambiguity, were linked with higher scores in depression, anxiety, and stress. The findings provided new insights concerning the aspects of the student-supervisor relationship that are related to the mental health issues of doctoral students in the UK. They have important implications for future research and supervision practice.

Two Preservice Teachers’ Adaptive Competence in Lesson Planning Across Two High School Placements

Purpose: To investigate the adaptive competence of two physical education preservice teachers (PSTs) across two high school placements. Methods: Two PSTs each taught four 6-lesson frisbee units across two different high schools. Feedback on lesson plans prior to teaching, guided reflection-on-action, and repeated teaching was used to support adaptations to six core teaching practices. PSTs made three iterations of each lesson plan. Results: PSTs made 589 adaptations across the core teaching practices of management (28%), task presentation (16%), content development (16%), active supervision (16%), goals and assessment (7%), and rules and routines (3%). Between 16% and 30% of adaptations were made in the last iteration. The number of adaptations decreased from the first to the second school placement and from Lessons 1 to 6. Conclusion: Feedback on lesson plans, guided reflection-on-action, and repeated teaching aided PSTs’ development of adaptive competence during school placements.

Application of Artificial Intelligence Technology in the Supervision of Customs Clearance Machine Inspection

The customs service plays a crucial role in keeping threats that endanger national security and social stability outside a country’s borders. However, illegal infiltration at the ports of entry is becoming more diverse and covert in its methods, which poses a greater challenge in effectively defending and controlling both traditional and non-traditional security threats. Additionally, with the intensification of competition in international trade and economic cooperation, and the growing demand for a better quality of life, enterprises are striving for fair competition, reduced trade costs and assurance of trade quality. This has resulted in a conflict between the goals of ‘supervision’ and ‘facilitation’. To address these challenges and improve customs operations, Customs should consider incorporating artificial intelligence (AI) and other technologies to develop ‘intelligent customs clearance and inspection’ methods. This study analyses the current deployment status and effectiveness of ‘intelligent customs inspection’ (ICI) in China, using it as a case study to highlight the need for innovative practices in customs clearance inspection supervision and to explore the future direction of ICI. The study demonstrates that the application of innovative intelligent technology practices could substantially improve the efficiency of customs clearance inspection.

Cohesive model of supervision: An empirically based approach

AbstractSupervision models are fundamental to our supervision practices and criticized for lacking empirical support. As a data‐driven approach based on research with expert supervisors, Cohesive Model of Supervision unifies existing models’ central premises in a meaningful manner and emphasizes the understated areas of supervision practice.

Impact of Instructional Supervision Strategies on Teacher Performance in Hinabangan Samar District 1

The effectiveness of instructional supervision strategies on teacher performance is a critical area of educational research. This study aimed to determine the effectiveness of different instructional supervision strategies employed by school heads and their impact on the instructional performance of teachers in the Hinabangan Samar District I. This study utilized the descriptive-correlational research design using the researcher-developed survey questionnaire administered to 81 public school teacher-respondents who were randomly sampled. The high effectiveness of school heads' instructional supervision practices in the Hinabangan Samar District I as evidenced by a composite mean of 4.82 highlights the positive influence of strong leadership and supportive practices. The very high positive correlation observed in the Hinabangan Samar District I reinforce the importance of robust supervision systems in educational settings. School heads should prioritize regular classroom observations, provide constructive feedback, and offer professional development opportunities. Additionally, fostering a collaborative culture among teachers can further enhance the effectiveness of instructional supervision.

Midwives’ perspectives and perceptions in relation to perinatal psychotic-like experiences: a qualitative study

ABSTRACT Background Psychotic-like experiences (PLEs) refer to subclinical experiences consistent with psychosis that may include hearing, feeling or seeing things that others cannot, or experiencing unusual beliefs. These experiences appear to be more common during the perinatal period. There appear to be barriers which make it difficult for midwives to support mothers with mental health difficulties. However, it is important that midwives can provide support with PLEs. Aim This study aimed to explore UK midwives’ perspectives and perceptions relating to mothers’ psychotic-like experiences in the perinatal period. Methods A qualitative study using semi-structured interviews with ten midwives recruited online was conducted. Transcripts were analysed using thematic analysis. Results Four themes were developed: (1) Identifying psychotic-like experiences would be complicated; (2) Psychotic-like experiences can feel overwhelming for women and midwives; (3) This is my responsibility: I’ll do what I can to support women even if it’s hard; and (4) The system feels unsafe and insecure which makes the anticipated role in supporting psychotic-like experiences harder. Conclusion Midwives described their motivation to support mothers with PLEs but articulated many factors that made this difficult. The results emphasise the importance of training and guidance for midwives to support them being able to offer support and information to mothers. The findings also highlight the importance of systemic safety for midwives alongside support through supervision and reflective practice.

Discrepancies between guidelines, preferences and actual activities in psychotherapy supervision

AbstractBackgroundClinical supervision, also known as consultation, is a key component of professional growth for psychotherapists, often involving activities like case discussions or practical exercises. However, the extent to which the content of supervision follows practice guidelines and whether supervision meets the preferences of psychotherapists is largely unclear.AimsThis study aimed to understand what psychotherapists prefer to do in clinical supervision and contrast that to what their supervision comprises. A secondary aim was to explore whether there were any differences in preferred activities between psychotherapists with different background variables, such as profession and training, and to examine associations between activities, supervision satisfaction and effectiveness.Materials &amp; MethodsPsychotherapists (N = 243, 84% women, mean age 46.3 years, SD = 10.6) completed an online survey regarding their supervision preferences and actual supervision activities.ResultsThe psychotherapists reported that formative activities, such as concrete exercises, discussing recorded material and modelling, were significantly more preferred than they were occurring in clinical supervision. The activities of teaching, modelling and discussions on emotional reactions, which are more associated with restoration, were associated with supervision satisfaction and competence. Psychotherapists with a cognitive behavioural therapy orientation preferred more active learning activities than other psychotherapists.ConclusionsOverall, neither the preferred nor the actual activities aligned with existing guidelines for supervision practices. Still, the therapists reported a preference for more experiential learning activities rather than more verbal activities.

A contemporary examination of instructional leadership activities and distributed leadership practices in elementary education

While the success of schools is often attributed to the efforts of principals, it is important to determine how schools can embrace distributed instructional leadership to enhance academic performance among learners. It is evident that instructional leadership alone is inadequate and necessitates complementation with a distributed leadership model. This study exclusively focuses on how instructional leadership aligns with distributed leadership, paying special attention to distributed instructional leadership implementation in primary schools in Zimbabwe. In this particular qualitative study, the interpretivist theory served as the guiding framework. The study involved observation and conducting interviews with school teachers and principals to gain insight into the instructional and distributive leadership activities that were taking place within their respective schools. The analysis of the data was approached through the lens of Hallinger and Murphy’s model of instructional leadership. The findings of the study highlighted the importance of active involvement from all members within a school for effective leadership. Furthermore, it was revealed that a holistic approach to school leadership styles is essential, emphasizing the interconnected nature of instructional and distributive leadership activities (distributed instructional leadership). The study ultimately determined that distributed instructional leadership is achieved through collaborative efforts in formulating school visions and embracing shared supervision practices among the members of staff. It was also identified that creating opportunities for staff development in the schools plays a pivotal role in reaching the goals of distributed instructional leadership.

An evaluation of a quality improvement initiative examining benefits and enablers and challenges and barriers of implementing and embedding core clinical supervision in primary care

Background Core Clinical Supervision has become a valued activity that impacts on the culture and organisational delivery of healthcare. It embeds good practice to ensure that staff have a high skill set, desirable professional attitudes, and provide high quality evidence-based care. It also helps to support good clinical governance and enhances staff retention (CQC 2013). A supervision framework has been adopted and adapted from the ‘General Practice – Developing confidence, capability, and capacity. A Ten Point Action Plan for General Practice Nursing’ ( NHS England 2018 ) and applied at scale across Yorkshire and the Humber, with minimal impact on clinical capacity, quality, and safety. This initiative coincides with general practice (and the wider health service) being under enormous pressure managing the effects of the COVID-19 pandemic, with impact on staff wellbeing and retention. The main aims are to evaluate the impact of embedding the Core Supervision training across primary care practice and strengthen course content for future delivery. Methodology and Methods A quantitative approach using an online survey, was completed by multi-professional primary care staff who had completed the Core Supervision Training. Findings Practitioners indicated that they required protected time due to competing demands and visible senior buy in to undertake core supervision. Additionally, practitioners who had participated or supervised sessions felt the benefits on staff wellbeing and indicated that it improved patient care delivery. Conclusion and Implications Survey findings suggest further research on embedding core supervision within primary care and a focus on national and local strategies are required. Standardised learning outcomes across the regions to ensure transferability of supervision practice and review training in supervision processes, particularly around conducting a supervision session.

Implementation of clinical nursing supervision with the proctor and reflective models: literature review

Nursing supervision can impact nurses' ability to generate, direct, and maintain behaviors relevant to nurses’ work environment. However, the fact is that oversight has not been implemented optimally. The following are the sample inclusion criteria in this research article: i) Research articles published between 2018 and 2023. ii) The article's research design is experimental or publication. iii) Research studies examine how the process of establishing vision supervision is carried out. iv) The research article is about clinical nurse supervision. A systematic review was performed in this study to assess 12 journals that were studied and included in the inclusion criteria. The findings of this investigation were achieved. The framework and clinical supervisor’s perceptions are divided into three themes: organizing learning, supporting tool for understanding what nursing care is, and developing own supervision practice. Supervisors view the fundamentals of care framework favorably and utilize it to structure and stimulate students' contemplation on what nursing is and demands.