TRaNSforM working definition of Clinical Supervision
Co-ordinating partner Portugal
Clinical Supervision is a formal, systematic and continuous process of professional support and learning, for practicing nurses, in which nurses are assisted in developing their practice through regular discussion with experienced colleagues and aims to promote autonomous decision-making, valuing the individual’s protection and safe care provision through reflective processes and clinical practice analysis.
Explanation from partners
Clinical Supervision has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing. It is an accepted strategy to identify solutions to problems, improve practice, and increase understanding of professional issues. Its relevance in nursing is in the potential benefits it can add to patient care and nurses as well, both individually and as a professional group. Not only does it help to prevent stress and burnout, it also contributes to job satisfaction. According to Proctor’s model, the functions of Clinical Supervision are "normative" (assess and assure quality), "restorative" (e.g. encourage emotional processing; support and assistance with coping; alleviate stress) and "formative" (e.g. maintaining and facilitating supervisees' competence, capability and general effectiveness).
Clinical Supervision is a formal, systematic and continuous process of professional support and learning, for practicing nurses, in which nurses are assisted in developing their practice through regular discussion with experienced colleagues with whom they can share clinical, organisational, developmental and emotional experiences.
Clinical Supervision aims to promote autonomous decision-making, valuing the individual’s protection and safe care provision through reflective processes and clinical practice analysis, with the ultimate goal of improving professional practice. The supervision process can also establish positive working relationships and cooperation with other colleagues. The focus of the supervision process is the progressive autonomy of the supervised.
The supervisor should be a qualified and expert nurse who acts both as a model and a reference in a secure confidential environment in order to enhance knowledge and professional skills. A supervisor should encourage the supervisee to become an active and engaged actor in the learning process toward positive change. The supervisor should take on the mission of helping and guiding the supervised, providing continuous and regular feedback on their performance. The supervisor is expected to listen, motivate, facilitate and stimulate, while developing a joint process with the supervised.
Clinical Supervision has no direct translation into German. However, “supervision” and “mentor” can be recognised in the German words (Greek and Latin being the origins). Referring to the concept of “false friends” in language teaching, we cannot assume that - because of the identical origin and the identical “looks” and “sounds” of these terms - their meaning must also be identical. In the TRaNSforM work on the identified terms and words, the literature renders analysis following relevant criteria, the starting point being that these words are used with different ideas in mind about what they actually mean and even different definitions. Clinical supervision may refer to a process, a formal role in the institution as well as a theory-based concept. They may aim at qualified nurses as well as nurse students. In Germany, there are similar approaches to such support and advice systems.
The term “Supervision” is protected and restricted to the activities of qualified “Supervisoren”. “Supervision” has its roots in social work. In 1989, the “German Association for Supervision e.V.” (DGSv) was founded. DGSv is a founding member of the Association of National Organizations for Supervision in Europe (ANSE). “Supervision” is a profession in its own right, aiming at the improvement of professional co-operation and communication. Many professional areas and domains appreciate the contribution of “Supervision” to improve occupational work and employment. “Supervision” is used to shape and improve the development of the company, department, team and/or employees. “Supervision” also stands for a theory-based concept of person- and organisation-related counselling in the occupational world. It focuses on issues, problem areas, conflicts and case studies from every-day work life.
As such, “Supervision” is not a concept specific to nursing. However, it might be found in the area of psychiatric care. In that context, though, it will be very close to a therapeutic understanding.
From a nursing perspective there are further support systems for nurses. “Pflegevisite” could be translated as “nursing rounds” (no other professionals take part) and is an instrument often referred to in the context of quality assurance in nursing. “Pflegevisite” firstly involves the patient and the primary nurse. Depending on the situation, there might also be a nursing student present, a clinical expert nurse or another expert. The main purpose of “Pflegevisite” is the assessment, analysis and discussion of the current care situation together with the patient. However, it is also sometimes used as an element of supervision for individual nurses. Recently, “Pflegevisite” is more and more viewed as an instrument for quality assurance and a tool to assess and measure outcomes in the context of economy and audit. “Kollegiale Beratung” can be translated as peer support or peer supervision. While in supervision the supervisor is an external expert (see above), “kollegiale Beratung” usually takes place between expert colleagues. Peer support meetings are used to discuss situations or cases and to jointly find solutions or action alternatives.
The term “Praxisanleiter” refers to qualified nurses with a particular further education course focusing on pedagogics and an extended role in the clinical environment. They are employed by the practice settings and while their main task is direct nursing care, their particular additional responsibility lies with the facilitation of the student nurse’s learning process while in practice. In short: the Praxisanleiters’ task is to transform the working process into a learning process for the student. In order to do this, they follow a structured process of working with the student, using particular methods based on specific learning theories (such as cognitive apprenticeship etc). In the discipline of vocational education science, “Praxisanleitung” is an important part of methodology. It aims at the linking of the various classrooms (school, university, practice setting) and enables the learner to recognise the relevance of their respective learning outcomes for the actual professional situations and actions. The pedagogical aim of “Praxisanleitung” is to step-by-step lead the nursing student towards independently taking over professional tasks and responsibilities. Regarding their role in the system, “Praxisanleiter” also have the task to keep the connection between school and practice setting; they are also involved in practice exams and different types of communication infrastructures between the schools, practice settings and students.
This role is regulated by the federal nursing law and the related examination regulation, and the existence of “Praxisanleiter” in the practice setting is a mandatory requirement for the institution to take part in education. The law specifies that the Praxisanleiter has to have at least 2 years professional experience as a qualified nurse before they can start with their Praxisanleiter qualification course. The term “Praxisanleiter” is specific for nurse education. In other vocational education or dual study settings, these educators have different names.
The term “Praxisbegleitung” refers to another support system of student nurses while in practice. “Praxisbegleitung” has to be performed by teachers from the school in addition to the work of the practice-based “Praxisanleiter”. This activity as one to secure students’ learning process in the practice setting as well as to secure the practice environment as a learning environment is also regulated by the federal nursing law and the related examination regulation. Through “Praxisbegleitung”, the school supports the practice setting in their educational task. While “Praxisanleitung” is the responsibility of the practice setting, “Praxisbegleitung” is the responsibility of the school. Activities pursued in “Praxisbegleitung” can involve individual or small group meetings with students for reflection, project work or work on a particular topic. “Praxisbegleitung” should also provide support for the clinicians who work as “Praxisanleiter”.
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