3 New Articles on Clinical Supervision – Implementing clinical supervision

TURNER, James and HILL, Alison (2011). Implementing clinical supervision (part 1): a review of the literature. Mental Health Nursing, 31 (3), 8-12


This article represents part one of a three-part series incorporating a review of the literature, a study relating to implementing clinical supervision into a ward-based environment and current practice in regards to the support of clinical supervisors in a community mental health setting. Proctor’s (1987) Tripartite model is the supervision model of choice and provides commonality between the studies. Clinical supervision remains a development target for many clinical areas, although for some the integration of supervision with practice has been fostered and supported for many years. The literature shows that implementation varies greatly between regions and disciplines. It seems therefore, that in the wider workforce, clinical supervision still requires commitment and energy to manage the time and continuity for successful practice. This paper reviews the literature on clinical supervision in nursing and allied helping professions in relation to the studies that will follow.

TURNER, James and HILL, Alison (2011). Implementing clinical supervision (part 2): using proctor’s model to structure the implementation of clinical supervision in a ward setting. Mental Health Nursing, 31 (4), 14-19

Abstract: This is the second of three articles on clinical supervision. This study was undertaken a number of years ago when there was limited but useful literature in press regarding the models of supervision available. Following a review of the literature Proctor’s (1987) model of clinical supervision was the model of choice. The authors’ objective through this series of papers, is to facilitate and enable wards an areas to set clinical supervision in motion. Although we are reporting here on a previous study the results and process have salience for current practice and lead into a more recent study on using evidence-based practice in clinical supervision. Through a mixed methodology, using a questionnaire to generate data, staff views on the usefulness of the model emerged.

HILL, Alison and TURNER, James (2011). Implementing clinical supervision (part 3): an evaluation of a clinical supervisor’s recovery-based resource and support package. Mental Health Nursing, 31 (5), 16-20

Abstract: This is the third of a series of articles exploring the implementation of clinical supervision. This study explored the effect of a support and educative package to clinical supervision in assisting the embedding of evidence-based practice and recovery values into their supervision sessions and also the impact on clinical supervision uptake. The study was based on an action research approach and had a mixed methodology that included questionnaire, focus groups and audit. The evaluation of findings showed that 94% of clinical supervisors felt that the package had a positive impact on their practice. However, uptake of clinical supervision remained unchanged over the evaluation period.

Lancashire Care staff can request all or any of these articles, email: susan.jennings@lancashirecare.nhs.uk

Clinical Nursing Leadership – A cognitive learning model

A cognitive learning model of clinical nursing leadership, Nurse Education Today, 2011, Vol. 31, Issue 3, Pages 268-273

Jacinthe Pepin



Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a “complex know–act” that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education.


Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

A study to evaluate the provision of psychosocial supervision within an Early Intervention team

A study to evaluate the provision of psychosocial supervision within an Early Intervention team, The Cognitive Behaviour Therapist ,  Volume 3,  Issue 02, pp 58 -70

Sandra T. Neil, Sarah Nothard, David Glentworth and Elaine Stewart

Bolton Early Intervention Team, Greater Manchester West, Mental Health NHS Foundation Trust, Paragon House, Bolton, UK


Psychosocial Interventions (PSIs) and PSI supervision underpin the delivery of early interventions for people experiencing psychosis. Early Intervention (EI) teams are relatively new in the NHS and there is currently a lack of empirical research into PSI supervision in this area. This study aimed to elicit staff views of PSI supervision and to identify any unmet supervision needs within a newly developed EI team in the UK. Semi-structured interviews were conducted with 16 multidisciplinary team members. Descriptive statistics and a thematic analysis were used to analyse the responses. The different types of supervision available to team members, gaps in the provision of PSI supervision and aspects that supervisees found helpful and unhelpful about PSI supervision are discussed as are ideas for improving the provision of PSI supervision in EI teams. The limitations of the study and ideas for further research are also outlined.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Evaluating the training of clinical supervisors: a pilot study using the fidelity framework

Evaluating the training of clinical supervisors: a pilot study using the fidelity framework, The Cognitive Behaviour Therapist , Volume 3, Issue 04, pp 132 -144

Tonia Culloty, Derek L. Milne and Alia I. Sheikh

Northumberland, Tyne & Wear Mental Health NHS Trust, St George’s Park Hospital, Morpeth, Northumberland, UK


 The evaluation of supervisor training has featured weak measurement and lacked a coherent framework, limiting effectiveness. A literature review was first conducted to clarify the current status of supervisor workshop evaluations, related to the promising fidelity framework. This consists of five criteria: the workshop’s design, the training (competence of the trainer), the delivery of the workshop, the learning of the participants (receipt), and the clinical practice outcomes (enactment). Second, we applied this framework to the training of supervisors (n = 17) in a cognitive-behavioural therapy (CBT) approach, by analysing one trainer leading two successive supervisors’ workshops. The review of the literature indicated that there were significant psychometric and conceptual deficiencies in the current evaluation of supervisor training. The data from the case-study analysis suggest that the manual-based workshop could be delivered with high fidelity by this trainer (e.g. the CBT approach to supervision received 89% approval). The fidelity framework provided a systematic, feasible and coherent rationale for the evaluation of supervisor training. Our preliminary findings indicated that the workshop was successful. To fulfil its promise as an improved way of evaluating supervisor training, the framework should be piloted with other trainers, instruments and workshops, using controlled designs.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Supporting prison nurses: an action research approach to education

Supporting prison nurses: an action research approach to education, British Journal of Nursing (BJN), 2010 Jun 24; 19 (12): 782-6

Bennett C; Perry J; Lapworth T; Davies J; Preece V;


Since April 2006, commissioning responsibility for healthcare services in public prisons has been fully devolved to NHS primary care trusts (PCTs), with the expectation that offenders will have access to the same range and quality of health services available to the wider population. In order to support prison nurses in meeting this goal, a PCT and university established a partnership, which used an action research approach to develop, instigate and evaluate a bespoke educational programme for nurses working in two local prisons. This article outlines the processes involved in the design and implementation of the programme. It also reports on findings from pre- and post-intervention questionnaires and focus groups with course participants, and semi-structured interviews with key stakeholders, which suggest that the innovation had a positive impact on the nurses’ confidence, assertiveness, clinical expertise and approach to change. The article concludes that the action research project should continue, but its scope should now broaden to address educational support for healthcare assistants, collaborative learning between prison officers and prison nurses, and the implementation of clinical supervision and action learning sets.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Attachment style and its relationship to working alliance in the supervision of British clinical psychology trainees

Attachment style and its relationship to working alliance in the supervision of British clinical psychology trainees , Clinical Psychology & Psychotherapy, early view, 2010

Joanne M. Dickson, Nicholas J. Moberly, Yehuda Marshall, James Reilly

Division of Clinical Psychology, University of Liverpool, Liverpool, UK
Mood Disorders Centre, University of Exeter, Exeter, UK
Pennine Care NHS Foundation Trust, The Royal Oldham Hospital, Oldham, UK


Although the supervisory relationship is thought to be critical in training clinical psychologists, little is known about factors affecting the supervisory alliance. We conducted an Internet survey of British clinical doctoral trainees (N = 259) in which participants rated their supervisory working alliance, parental style during childhood, pathological adult attachment behaviours and attachment style for themselves and their supervisors. Trainees’ ratings of the working alliance were associated with perceptions of supervisors’ attachment style, but not with perceptions of trainees’ own attachment styles. Path analysis supported a causal chain linking parental indifference, compulsive self-reliance, insecure supervisor attachment style and lower ratings of the working alliance. Our results broadly replicate data from a US sample and suggest that attachment theory is helpful in understanding clinical supervisory processes.

The attachment theory is helpful in understanding clinical supervisory processes.
Perceptions of supervisors’ attachment style are associated with quality of the supervisory working alliance.
Compulsive self-reliance in trainees may present particular difficulties for the supervisory working alliance

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Guiding students through reflective practice – Most Read Article

Guiding students through reflective practice – The preceptors experiences. A qualitative descriptive study, Nurse Education in Practice, Volume 9, Issue 3, May 2009, Pages 166-175

Anita Duffy

Lecturer/Course Co-ordinator, School of Nursing and Midwifery, Trinity College Dublin, 24, D’Olier St. Dublin 2, Ireland


Nurse Education in Ireland has experienced a significant change over the last 10 years. As a consequence staff nurses must be prepared to support student learning and enable student learners obtain an optimum educational outcome, thereby enriching the students’ clinical placement. ‘Reflective time’ has been included in the rostered year to enhance the consolidation of theory and practice. The nurse preceptor can facilitate students to reflect on their practice through guided reflection. This study presents the experiences of seven preceptors towards guiding student nurses through reflective practice in the clinical practice area.


A qualitative descriptive research methodology was chosen to research this phenomenon. Semi-structured qualitative interviews were undertaken with a purposive sample of seven student nurse preceptors. All the interviews were transcribed verbatim and analysed using Burnard’s [Burnard, P., 1991. A method of analysing interview transcripts in qualitative research. Nurse Education Today, 11(6), 461–466] 14-stage method of thematic analysis.


Analysis of the data revealed that preceptors had little or no experience of using guided reflection within the preceptorship process. Factors, which contributed to these findings included the training and development of preceptors, the critical relationships within the preceptorship process, and the preceptors’ experiences of reflection in the past and present, not withstanding the anticipated future benefits of using guided reflection to aid student learning.


Guided reflection is a relatively new concept in Irish nursing with this study generating data on seven preceptors’ experiences of using guided reflection in the preceptorship process. The study caused the participants to deeply reflect on their own knowledge and understanding of guided reflection and how guided reflection has the potential to facilitate the development and maintenance of the student nurse/preceptor relationship.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Supervision reviewed: reflections on two different social work models in England and Sweden

Supervision reviewed: reflections on two different social work models in England and Sweden, European Journal of Social Work, 1468-2664, Volume 12, Issue 1,  2009, Pages 71 – 85

Greta Bradley – Department of Social Policy and Social Work, University of York, UK


This article draws on the findings of two independent research projects on supervision: one based in England and the second in Sweden. The findings cited illustrate predominantly the perspectives on supervision held by social workers and managers in the statutory services. In the process of contextualising, theorising and pulling together the threads from their respective findings, the authors reflect on the fabric and models of supervision in the two countries. The opportunities and disadvantages of the two contrasting models in current practice are discussed. This includes the steps that could be taken in either country to improve the quality of supervision within learning organisations.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecar.nhs.uk

Can we enhance the training of clinical supervisors? A national pilot study of an evidence-based approach

Can we enhance the training of clinical supervisors? A national pilot study of an evidence-based approach , Clinical Psychology & Psychotherapy, 2009

Derek Milne
Northumberland, Tyne and Wear NHS Trust and the Doctorate in Clinical Psychology, Newcastle University


Clinical supervision plays an essential part in maintaining professional standards and in achieving the National Health Service’s objective of a modern workforce. Paradoxically, little is known about how supervisors themselves acquire competence, leading to lament that something does not compute. To contribute to a solution, a supervisor training manual that guided trainers in delivering continuing professional development to supervisors in an evidence-based approach to clinical supervision was piloted nationally, in terms of the reactions of trainers (N = 25 tutors from clinical psychology courses) and their workshop delegates (N = 256 clinical psychology supervisors). Trainers were allocated randomly to either manual-alone or to a manual-plus consultancy group. The trainers all rated the manual favourably (mean rating of 78%), but there was no significant difference between the two groups. However, the supervisors within the consultancy group rated the sessions significantly more highly than their counterparts. It is concluded that brief training in an evidence-based approach appears feasible and acceptable, making more rigorous evaluations appropriate.
Key Practitioner Message:

  Clinical supervision is now recognised as essential, yet supervisors tend to receive little or no training, which tends not to be evidence based.
  A training guide in evidence-based clinical supervision has been disseminated and evaluated, in terms of the acceptability of the approach taken to supervision.
  The reactions of trainers and supervisors (all associated with clinical psychology training programmes) to this guide were positive, indicating that it merits further development and more rigorous evaluation.


Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Acquiring and Refining CBT Skills and Competencies: Which Training Methods are Perceived to be Most Effective?

Acquiring and Refining CBT Skills and Competencies: Which Training Methods are Perceived to be Most Effective? Behavioural and Cognitive Psychotherapy, 2009

James Bennett-Levya1, Freda McManusa2, Bengt E. Westlinga3 and Melanie Fennella4

a1 University of Sydney and Southern Cross University, Australia
a2 Oxford Cognitive Therapy Centre, UK
a3 University of Uppsala, Sweden
a4 Oxford Cognitive Therapy Centre, UK



Background: A theoretical and empirical base for CBT training and supervision has started to emerge. Increasingly sophisticated maps of CBT therapist competencies have recently been developed, and there is evidence that CBT training and supervision can produce enhancement of CBT skills. However, the evidence base suggesting which specific training techniques are most effective for the development of CBT competencies is lacking. Aims: This paper addresses the question: What training or supervision methods are perceived by experienced therapists to be most effective for training CBT competencies? Method: 120 experienced CBT therapists rated which training or supervision methods in their experience had been most effective in enhancing different types of therapy-relevant knowledge or skills. Results: In line with the main prediction, it was found that different training methods were perceived to be differentially effective. For instance, reading, lectures/talks and modelling were perceived to be most useful for the acquisition of declarative knowledge, while enactive learning strategies (role-play, self-experiential work), together with modelling and reflective practice, were perceived to be most effective in enhancing procedural skills. Self-experiential work and reflective practice were seen as particularly helpful in improving reflective capability and interpersonal skills. Conclusions: The study provides a framework for thinking about the acquisition and refinement of therapist skills that may help trainers, supervisors and clinicians target their learning objectives with the most effective training strategies.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The side effects of evidence-based training – Staff well-being

The side effects of evidence-based training, Journal of Psychiatric and Mental Health Nursing, Online early view, 2009


The mental health inpatient workforce has been targeted for continuing training to promote improved practice and enhance morale. The effects of intensive training and innovations in clinical practice on staff well-being are poorly understood. The aim of this paper is to measure the impact of a programme of team training and clinical practice development on levels of stress, job satisfaction and burnout in inpatient mental health workers. A repeated measures design was used in which participants acted as their controls. Participants were assessed before and after training using standardized measures of stress and burnout. During the training period, mean scores on all measures remained stable. Over the practice implementation period, there were significant increases in perceived stress and burnout and a significant reduction in job satisfaction. Training in novel psychosocial interventions had no impact on staff psychological well-being and satisfaction. Attempting to implement, these interventions did appear to have harmful effects. Intensive clinical support to sustain novel practices did not prevent these outcomes.

Lancashire Care staff can request the full-text of this article, email: susan.jennings@lancashirecare.nhs.uk

Implementing clinical supervision: Part 1, Part 2 & Part 3

Implementing clinical supervision: Part 1: Laying the ground work, International Journal of Mental Health Nursing, 2008,  Volume 17 Issue 1, Pages 57 - 64

Implementation of clinical supervision in action: Part 2: Implementation and beyond , International Journal of Mental Health Nursing, 2008,  Volume 17 Issue 1, Pages 65 – 72

Implementation of clinical supervision in action: Part 3: The development of a model, International Journal of Mental Health Nursing, 2008,  Volume 17 Issue 1, Pages 73 – 82

Australia, like other countries, is experiencing a crisis in the recruitment and retention of nurses. Clinical supervision has been suggested as a potential strategy to enhance retention. However, there is a paucity of literature regarding the successful implementation of clinical supervision. The aim of this study is to explore and evaluate ways of implementing clinical supervision as undertaken in a rural health-care organization in Victoria. Qualitative methodology was used including a documentation audit and individual interviews with the staff responsible for implementation. The findings demonstrate that the successful implementation had occurred in five interrelated stages. This paper, one in a series of three, focuses on the preimplementation phase leading up to initial implementation. The main themes identified during these stages were: organizational culture, exploring the possibilities, leadership and education and training which will be examined. These issues were essential in laying the foundation for the systematic introduction of clinical supervision.

For the full-text of the articles above please email: susan.jennings@lancashirecare.nhs.uk


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