benefits of using clinical supervision, The

Mental Health Nursing,  Jan/Feb 2002  by Veeramah, Ven

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In this paper Ven Veeramah looks at the concept of clinical supervision and examines the benefits it can bring. A postal questionnaire was sent to a sample of 165 community mental health nurses from two NHS trusts to assess their use and perceived benefits of clinical supervision. Overall, the findings indicate that the two trusts are fully committed to providing clinical supervision to all their staff regardless of their clinical grades. Also, most respondents reported that they are currently receiving clinical supervision and expressed very positive views. However, a significant number of the supervisees and supervisors stated that they would appreciate some further training if they were to derive the maximum benefits from the sessions

According to Lyth (2000), clinical supervision has become an important concept in nursing because of the benefits it can bring to both patient care and nurses. Sloan (1999) and Cutcliffe and Proctor (1998a) highlight some of these expectations as the development of clinical competence and knowledge base (Dudley and Butterworth, 1994; Barton-Wright, 1994; Bishop, 1994; Nicklin, 1995); an improvement in the quality of patient care (Bishop, 1994; Goorapah, 1997) and an increase in nursing staff's confidence in the delivery of care (Bishop, 1994; Cutcliffe and Epling, 1997). They also identify the outcome that nursing staff would feel more supported (Butterworth et al, 1996; Cutcliffe and Epling, 1997); a reduction in the level of stress experienced by nursing staff and burnout (Firth, 1986; Faugier, 1994; Hallberg and Norberg, 1993); a decrease in staff leaving nursing as well as a reduction in the number of complaints to the health service (Nicklin, 1995; Goorapah, 1997). Furthermore, it could lead to higher staff morale and satisfaction resulting in a decrease in staff sickness/absence (Butterworth et al, 1996).

Fowler (1996a), in his review of the literature, concludes that there is a clear indication that clinical supervision is a `good thing' and the concept in some form has gained widespread acceptance within the nursing profession. However, he asserts that `the evidence on which the various writers make these assumptions is limited' (Fowler, 1996a: 472). This is further supported by Sloan (1999) who maintains that, although there are many anecdotal accounts of the benefits and outcomes of clinical supervision to both nursing and client care in a wide variety of settings, there is comparatively little empirical evidence available. This view is also endorsed by Butterworth et al (1997:2) who observe that most of the literature appears to be on `philosophical debates, models, processes and method of delivery' and `most accounts are based on individual enthusiasm, personal accounts and anecdotal reports'.

There are a few empirical studies that highlight some of the benefits of clinical supervision. However, they all used small selective samples which make generalisation of the findings difficult. Berg et al (1994) found that systematic clinical supervision decreased the level of stress among staff when attempting to provide individualised planned care to a group of patients suffering from dementia. Similarly, in the studies by Hallberg and Norberg (1993) and Hallberg (1994), staff reported improved nursepatient relationships, reduced stress level, increased self-confidence and a broader and better knowledge base.

In more recent studies, Bowles and Young (1999), using Proctor's three function interactive model found that mental health nurses said they perceived clear benefits in terms of accountability of care provided, skill development and support received. White et al (1998) reported some personal benefits experienced by the participants broadly related to an increase or, at least, no further deterioration in well-being which was achieved through being able to share difficult experiences with someone who was prepared to listen. Scanlon and Weir (1997) also found that nurses in their study had a positive perception of the potential value of clinical supervision. These nurses reported they were better able to reflect upon the nature of their own formative learning needs.

In Malin's (2000) study, a small sample of staff supporting and caring for learning disabled adults living in community homes reported improved teamwork relations and the

opportunity to reflect on practice. In addition, Sloan (1999) cites that the initial findings from the studies by Fowler (1995), Butterworth et al (1997) and his own (Sloan, 1997), indicate that nurses who were engaged in clinical supervision expressed the feeling of being supported in their practice.

Study

The purpose is to explore the use and perceived benefits of clinical supervision by community mental health nurses (CMHNs) working within two large neighbouring NHS trusts in the south east of England. The study aims to assess CMHNs' use of clinical supervision in practice, explore their views regarding the goals and benefits of clinical supervision and to identify any training needs of both supervisors and supervisees.