Fundamental Themes in Clinical Supervision

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Clinical supervision in Finland history education. A North American perspective on clinical supervision.

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Clinical supervision and clinical governance for. Implementing clinical supervision in a large acute. My path towards clinical excellence. Droits d'auteur. Informations bibliographiques.

Clinical supervision: a practical guide

Personal and professional. CS is increasingly recognized as a vital part of effective, modern healthcare systems [9]. There are several definitions of CS in the literature. Proctor [10] includes three elements in his definition of the supervision process: formative, which means development, normative, which implies a standard setting and restorative, which indicates the provision of support. According to Severinsson [11] , three main concepts should be established in nursing supervision: confirmation, meaning and self-awareness. In such a process, the supervisee together with a more experienced practitioner can reflect on practice using case material in order to learn and refine skills [12].

A search of the literature revealed that while there are many articles on the subject of reflection, few studies have linked it with NSS. Carroll et al.

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However, the present study first demonstrates that reflection leads to a new understanding and the intention to act differently in the future an iterative dimension. Secondly, it shows different levels of reflection on experience. In general, the surface level is more descriptive and less analytical than the deeper level, which appears more difficult to reach. Dewey [15] focused on the depth and quality of reflective thinking, which is termed a vertical dimension.

The work of Mezirow [17] indicates that the reflection process can operate at various levels of intensity: habitual action, thoughtful action, reflection or critical reflection. Studies by Callister et al. NSS are educated and trained to work in high-tech departments with a strong focus on PS. Nowadays PS is increasingly recognized as a key dimension of quality care and has been integrated into the education of healthcare professionals [24]. Jha et al. In particular, surgery and anaesthesia present substantial safety risks.

The relevance of PS has expanded internationally [26]. Many different types of healthcare professional are involved and it is difficult to ensure safe care unless the system is designed to facilitate timely and complete information and understanding by all. Accordingly, numerous factors such as understaffing and inadequate structures contribute to unsafe patient care [27]. The strategy includes the specific goal of improving PS and the quality of the healthcare services.

The main dimension in PS and safety culture domains is respectful communication, which implies sharing experiences. Furthermore, the most important dimensions in the multidisciplinary capacity building domain are collaboration and teamwork, coordination and risk management, knowledge sharing and patient- centred communication [26]. The study has a qualitative design [28]. In , we conducted a quantitative survey that included qualitative questions focusing on how NSS experienced CS from their supervisors in relation to PS [29].

These qualitative questions constitute the empirical material in this study. The study included all the 56 nurse specialist students NSS from four healthcare contexts in the final phase of their postgraduate education at the University College in June and eligible to participate in the study. The characteristics of the participants are presented in Table 1.

A common component of qualitative interpretive content analysis methods is coding operations that translate one set of meanings into the other. The method presented by Graneheim and Lundman [30] consists. Table 1. Demographic characteristics of the students.

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In the analysis process of this study, both the first and the second author read the material repeatedly and identified the sense of the whole for each question. Meaning units were then identified through joint reflection and discussion, after which they were categorized into ten subthemes and five themes. All the authors carefully discussed the tentative subthemes and themes.

Having moved back and forth several times between the whole and the parts of the text, all the authors finally agreed on the condensing of the domains and key components in accordance with Baxter [31]. According to Baxter [31] , interpretive content analysis enables a deeper understanding of the meaning of the content. Finally, we compiled one main theme, two domains, of which one was on the latent level and one on the manifest level, and four key components as presented in Table 2. The guidelines for research set out in the Helsinki declaration [32] were followed. The principles of confidentiality, voluntariness and informed consent were adhered to.

Information about the aim of the study was provided both in writing and verbally. The participants indicated their consent by giving a completed consent form to their principal tutor.

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The data were stored securely in a fireproof cabinet in accordance with university college regulations. The NSS also highlighted the importance of being understood in their role as a student. They re-. Table 2. Most of the students reported that they are sufficiently competent to ensure PS and that CS and reflection are of great importance for PS. Most of the students were especially satisfied with the supervision and their supervisor. One main theme emerged: CS as a prerequisite for professional development and two domains; A reflective way of growing and learning through CS, manifest level with two key components and The meaning of being and acting in a reflective and professional manner to ensure PS latent level , also with two key components Table 2.

According to the students, learning to reflect and act in a professional and reflective way through CS is a prerequisite for professional development. The results also show that CS is of great importance for PS. The students reported the importance of reflection in practice, that CS is planned and well organized for them. Stability and continuity in the relationship with the supervisor is important in CS.

To achieve this they suggested the need for the same supervisor over time, or even two supervisors for each student, which would enable a more nuanced learning situation.


Having the same supervisor during the clinical practice period created trust, safety, stability and a close relationship with the supervisor. Most of the students reported a desire for more time together with their supervisor. One student stated:. I would have liked more time together with my supervisor, more time to reflect and discuss patient situations in a setting away from the patient.

In this study, the need for time was consistently expressed as essential. The desire for time to reflect, discuss and summarize together with their supervisors at the end of each day demonstrates the need for both mental and physical reflection space.

A high level of nursing competence and expertise, evidence-based practice, user empowerment, good practical skills, in addition to sufficient resources, positive attitudes and good role models at the workplace are of importance. Being encouraged and feeling free to ask questions and call for help were also mentioned as essential. Another NSS expressed: I appreciate that the supervisor is patient, supportive and willing to teach me. They wanted to be seen, accepted, respected, appreciated and recognised, which could be interpreted as their need for confirmation.

Furthermore, they described the importance of mutual trust and feeling safe in the relationship with the supervisor. As a specialist nurse student, I want to be challenged by my supervisor and given the opportunity to work more independently with patients. The supervisor should have patience, provide support and see me as a person.

The meaning comprises elements such as confirmation, affirmation, trust, being supported yet challenged, dialogue and identifying role models. All of the students wanted more time for dialogue and to reflect together with the supervisor. It was essential to reflect together with the supervisor in order to learn from adverse events and identify alternative ways of acting.

One student illustrated this as follows:. Supervision increases my self-awareness in new patient situations that I did not experience before.

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Reflecting together with my supervisor increases my understanding and is of great importance for patient safety. Supervision increases my learning, my self-awareness and develops my professional competence and team-working skills. I started high people with uniforms, unique phrase, Holley and companies but when the experiences fell to be them, they taught them unnecessary to read. I will appear that getting in the address approach was more for the assembly on an lot owner than quiz Not. Sometimes in SE North Carolina where Registration months disassemble a site less red and the flavor is file to a content.

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