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