Mentoring and Clinical Supervision in Nursing Practice - Essay Example

Mentoring and Clinical Supervision in Nursing Practice Introduction: Mentoring important in nursing since the nursing is not just certification, itinvolves gradual and progressive development of commitment to serve the ailing human beings. This involves transmission of knowledge and experience in the clinical setting to develop practice with collegiality between the veterans in the profession and the new entrants. The system ensures support for one another within the discipline of nursing. By establishing patterns of engagement within the clinical workspace, the seasoned veterans connect with their novice colleagues to promote standards of excellence and scholarship based on evidence-based knowledge. The apparent gap between the scholarship, academy, knowledge, and learning can actually only be bridged by a constant supervision while rendering clinical activity and care by the mentors of the mentees Mentoring and Clinical Supervision: Although there is a growing concern regarding the frustration related to today's nursing environment, an attitude change is enough to beget drastic changes in the status of healthcare nursing. This is the time of rapid and phenomenal changes in the pattern of healthcare delivery mainly due to advancement in technology and progressive development of the cult of increasing application of research to accomplish evidence-based care (Mills, J.E., Francis, K.L., and Bonner, A., 2005). Despite the problem apparently is crucial, the solution to issues in the nursing work environment and nursing practice parallels it since the nurses have the opportunity to use the power that already exists in the role of bedside nurses, and that role is that of mentoring that involves clinical supervision in implementing practice. Through mentoring, the nurses can continue to create common bond, feelings of acceptance, and a sense of loyalty within the profession (Browne-Ferrigno, T. and Muth, R., 2004). Role of Clinical Supervision: Mentoring and clinical supervision are critical in nursing. The nurses are constantly faced with the daily challenge of providing care in a setting characterized by increased patient acuity, inadequate staffing, and sparse resources. These conditions leave little time for providing leadership and patience, sharing experiences with a new nurse, and thus building and trusting relationship required for the mentoring process. Despite the current hectic environment, nurses must make the time to mentor and supervise juniors (Yegdich, T., 2000). Taking the example of critical care nursing that involves sound knowledge of instruments, gadgets, medicines, and the physiology of life, one can easily assume that experienced critical care nurses have a knowledge base of vast clinical expertise, and in that clinical area, nothing happens outside evidence-based practice, and therefore, management of care of the patients is not possible without the wisdom and expertise acquired over time (Jenkins, E., Rafferty, M., and Parke, S., 2000). Impact on Knowledge: Nurses who are blessed with both knowledge and expertise mainly due to extended clinical experience would naturally be called for these leadership roles including mentoring and clinical supervision in professional development of junior nurses. They are in a position to offer continuing education, to provide opportunity for growth, to encourage certification among the mentees and the supervised, and ultimately in this way, to facilitate the opportunity for the new nurse to network with others in her area (Rafferty, M.A., 2000). The nurses do have the power and capability to make a difference, thus, not only in the lives of the patients and their families cared for but also to imbibe energy and interest in the practice environment with continued mentoring and clinical supervision of one nurse at a time. It demands a belief and love for the job and confidence that changes can be brought about in the environment of work involving the care of the patients by a process of progressive and developmental nurturing of those who will follow the footsteps of the seniors, to empower each other as well as the new faces that are encountered in each shift (Rafferty, M., Jenkins, E., and Parke, S., 2003). Impact on Profession: While confronting new realities and assuming new responsibilities, one of the new responsibilities for nurses is the adoption of a model of clinical supervision in order to improve clinical practice. Clinical supervision, therefore, is a process of professional support and learning that enables individual practitioners to develop knowledge and competence to be able to assume newer and more critical responsibilities for their own practice and enhance consumer protection and safety of the patients in a complex situation (Sloan, G., White, C., and Coit, F., 2000). This concept translated into nursing practice would appear as experienced nurses providing guidance to less experienced nurses in their clinical work. A clinical decision in the practice area is guided by several different steps. These are identification of the problem encountered in profession, gathering information, identification of the patient's preferences, identification of the ethical issues, identification of the existing alternatives, analysis of their consequences, determination of a choice, and theoretical and experienced-based justification underpinning evidence-based practice. This is essentially a contextual framework that revolves around the rational aspects between the patient and the nurse, but a point to note here is that of its implications on impact on the organizational structure in the care setting (McCloughen, A., O'Brien, L., and Jackson, D., 2006). Significance in Healthcare: Clinical supervision applied in healthcare also has similarities in several aspects. When a nurse engages herself in clinical supervision and mentoring in nursing practice, she identifies the problem, gathers information, considers questions from the supervisees and mentees, and helps them to identify the existing alternatives. The supervisor and the supervisee raise questions, explore, explain, and systematize experiences from clinical care in a professional context. This process has the innate benefit of positive influence on the supervised nurses' ability to make a professional decision regarding care (Sloan, G. and Watson, H., 2001). It has been found that the nurses gain increased self-assurance and an increased ability to enter into a relationship with the patient. The reason is simple; the supervised nurses think themselves more capable to assume greater responsibility for providing care on the basis of their own decision making. The other dimension of this process might have long-lasting effects on the process of patients care (Teasdale, K., Brocklehurst, N., and Thom, N., 2001). Benefits: The identified benefit of clinical supervision is extension of interpersonal dimension, reflecting the nurses' use of self that promotes a close nurse-patient collaborative relationship. The dimension of communicative abilities also enhance by the way of explaining a problem and being explained a solution in terms of professional activities in the care setting while being supervised and mentored for fine tuning of practice based on evidence and theoretical, academic teaching (Davey, B., Desousa, C., Robinson, S., and Murrells, T., 2006). This opens up another area that appears apparently unrelated to the said benefit. This reflects a nurse's provision of information or teaching of the patients that generates from the newly gained increased sensibility to the patients' needs. Most important, this process exposes the nurse to team dimensions that has in-built security and provisions for creativity (Van Ooijen, E., 2000). Accepted Models: There are two accepted and established models of clinical supervision that focus on supervision and preceptorship or mentorship respectively. Clinical teaching is a significant counterpart of these, and part from the relationship of a teacher's role and the students' results, the relationship between the two as a personal level also counts a lot in such a process (Spence, C., Cantrell, J., Christie. I., and Samet, W., 2002). The nature of the supervisor-supervisee relationship is important in achieving the intended results, but the problem arises from the apparent contradictory roles subserved by the supervisor. The supervisor facilitates the learning process by offering the comfort of personal warmth, yet is supposed to challenge the supervisee to obtain proof of professional growth (Aston, L. and Molassiotis, A., 2003). Necessity: The nursing practice needs supervision in order to enable practitioners to establish, promote, and maintain standards and innovations in clinical practice in the interests of the patients. The idea of peer exchanges between professional nurses is to enable development of skills. The supervisor is required to facilitate a relationship in which the supervisee could reflect upon, critically analyze, and evaluate their everyday practice that in turn facilitates professional development. Broadly defined, clinical supervision is a meeting of exchange between two or more people who have a declared interest in examining a piece of work related to profession. The work is presented in order to be reviewed, scrutinized, and examined in an environment where they will together think about what was happening and why, what was done and said, and how the problem was handled overall )Walsh, K., Nicholson, J., Keough, C., Pridham, R., Kramer, M. and Jeffrey, J., 2003). If there are other options in handling the same problem, this creates an opportunity for both to brainstorm and come into a consensus or difference. This essentially is thus an opportunity to learn in the context of ongoing professional relationship with an experienced practitioner to be able to engage in guided reflection on current practice in ways designed to develop and enhance that practice in future. Despite difference in the definitions, thus, clinical supervision is focused on provision for empathic support to improve therapeutic skills, transmission of knowledge, and facilitation of reflective practice in nursing (Noelker, L.S., Ejaz, F.K., Menne, H. L., and Jones, J.A., 2006). Mentoring: Mentoring in nursing practice is a process associated with teaching and learning. This is acquired through personal experience with one-to-one reciprocal career-development relationship. The mentor would be senior in age, personality, life cycle, professional status, and professional credentials. This relationship exists for a period of several years for professional outcomes, such as, research and scholarship (Winstanley J., 1999). Application and Approach: There are several models of clinical supervision in nursing practice. The growth and support model entrusts the supervisor to facilitate growth both educationally and personally in the supervisee, and the supervisor makes certain to provide support to the nurses' developing clinical autonomy. The elements in such a relationship are generosity, rewarding, openness with a personal touch, practicality, and trust. The supervisor is willing to learn and at the same time wants the supervisee to be willing to learn and is sensitive to the weakness and strength of the supervisee, yet uncompromising in the quality that is to be developed in the supervisee (Nursing and Midwifery Council, (2006). The supervisor is thoughtful so that the posed questions would provoke thought in the nurse concerned. Each of these aspects are offered as a framework to serve as a basis for the supervisory relationship, and using that as a guide, the supervisors can ensure that all these essential elements of the relationship get due emphasis (Magnusson, A., Lutzen, K., and Severinsson, E., 2002). Difficulties: This is not an easy task to accomplish, and the complex interplay of human relationship and demand of the discipline has generated a simpler yet closer approach. This is known as integrative model where the process of clinical supervision is deployed in four components. These are supervisor, supervisee, client or the patient, and the context of work. Analysed, this process is actually a combination of two interlocking systems, one the therapy system that connects the client and the supervisee and the system of supervision that involves the supervisor and the supervisee (Rodenhauser, P., Rudisill, J.R., and Dvorak, R., 2000). Relationship between Systems: The only common thing that connects these two systems is an agreed contract of time spent together through negotiated shared tasks and goals. Perhaps the best practical model is Proctor's three-function interactive model of clinical supervision where its three active components, namely, normative or managerial, formative or educative, and restorative or pastoral support come into play. Like all others models, the phenomena are never isolated, rather they are interactive and interrelated. The normative component comprises of promoting and complying with policies and procedures, developing standards, and contributing to clinical audit (Shanfield, S.B., Hetherly, V.V., and Matthews, K.L., 2001). Thus in this process, the supervised nurse gets acquainted with the managerial aspect of the nursing activity, which is a very important skill to be acquired in the clinical area where legislations and guidelines are extremely strict and a must to be employed. The formative aspect looks after skills development in order to develop evidence-based nursing practice. This is an educative approach where the gap between scholarship and practice happens, and the supervisor marks the key points in the clinical setting which interprets the client findings in the light of academic teachings, or in other words, the nurse being supervised starts learning from the patients who serve as the pages of the books (Mantzoukas, S. and Jasper, M.A., 2004). Human Factors: This process is stressful, and there will evidently be human factors of exaltation of achievement and depressions for failure to perform. The role of the clinical supervisor becomes crucial since in the third mode, she has a restorative role to play by providing pastoral support that enables the practitioners to understand and manage the emotional stress of the nursing practice. Clearly, the presence or absence of these three elements will govern the relative success of the supervisory process that is an integrated system of these very important contributing factors (McKay A., 1986). Implementation: Talking about actual implementation, the content of the clinical supervision usually remains confidential based on a contract of agreement between the supervisor and the supervisee. The session can be undertaken on a one-to-one basis, that is, privately between one supervisor and one supervisee. This can alternatively be done in a group session where the supervisor leads the session with a group of supervisees together. Peer group supervision sessions have gained popularity of late, mainly due to the fact that that ensures better, free, and pastoral interactions (Mullarky, K., Keeley, P., and Playle, J.F., 2001). Variations: Such variations in the structure and process of clinical supervision have occurred largely as a result of local policy and managerial decisions that basically follows an organizational decision about how to integrate clinical supervision into a working practice. The other variables favouring such decisions would obviously be indicated by the workload and the specific discipline of the clinical area where clinical supervision is implemented. The manner in which the clinical supervision is implemented in the community nursing would be different from that of hospital-based nursing, and that would grossly differ from speciality to speciality (Landmark. B., Storm-Hansen, G., Bjones. I., and Bhler, A., 2003). Conclusion: The delivery of clinical supervision has been implemented in a variety of ways, and the best implementation strategies have always been gleaned from research in this field. The actual implementation would take time to develop into a full form in a considerable period of time, so the institutional decision to implement clinical supervision will always take time, and thus even if assessment is necessary to prove its fruitfulness, adequate time must be allowed to review the process. Whatever may the case be, clinical supervision and mentoring are two wonderful tools for academic socializing within the fraternity of nursing where the older takes care for the appropriate development of the younger. References Aston, L. and Molassiotis, A., (2003). Supervising And Supporting Student Nurses In Clinical Placements: The Peer Support Initiative. Nurse Education Today ; 23(3): pp. 202-10. Browne-Ferrigno, T. and Muth, R., (2004). Leadership Mentoring in Clinical Practice: Role Socialization, Professional Development, and Capacity Building. Educational Administration Quarterly; 40: pp. 468 - 494. Davey, B., Desousa, C., Robinson, S., and Murrells, T., (2006). The Policy-Practice Divide: Who Has Clinical Supervision In Nursing Journal of Research in Nursing; 11: pp. 237 - 248. Jenkins, E., Rafferty, M., and Parke, S., (2000). Clinical Supervision: What Is Going On In West Wales Results Of A Telephone Survey. Nursing Times Research; 5: pp. 21 - 36. Landmark. B., Storm-Hansen, G., Bjones. I., and Bhler, A., (2003). Clinical Supervision - Factors Defined By Nurses As Influential Upon The Development Of Competence And Skills In Supervision. Journal of Clinical Nursing; 12 (6), pp. 834-841. Magnusson, A., Lutzen, K., and Severinsson, E., (2002). The Influence Of Clinical Supervision On Ethical Issues In Home Care Of People With Mental Illness In Sweden. Journal of Nursing Management; 10 (1), 37. Mantzoukas, S. and Jasper, M.A., (2004). Reflective Practice And Daily Ward Reality: A Covert Power Game. Journal of Clinical Nursing; 13 (8), pp. 925-933. McCloughen, A., O'Brien, L., and Jackson, D., (2006). Positioning Mentorship Within Australian Nursing Contexts: A Literature Review. Contemporary Nurse; 23(1): pp. 120-34. McKay A., (1986). Non-managerial supervision. In Enabling and Ensuring Supervision in Practice (M. Marken & M. Payne eds),National Youth Bureau, Leicester. Mills, J.E., Francis, K.L., and Bonner, A., (2005). Mentoring, Clinical Supervision And Preceptoring: Clarifying The Conceptual Definitions For Australian Rural Nurses. A Review Of The Literature. Rural Remote Health; 5(3): 410. Mullarky, K., Keeley, P., and Playle, J.F., (2001). Multiprofessional Clinical Supervision: Challenges For Mental Health Nurses. Journal of Psychiatric and Mental Health Nursing; 8 (3), pp. 205-211. Noelker, L.S., Ejaz, F.K., Menne, H. L., and Jones, J.A., (2006). The Impact of Stress and Support on Nursing Assistant Satisfaction With Supervision. Journal of Applied Gerontology; 25: pp. 307 - 323. Nursing and Midwifery Council, (2006). Clinical Supervision. Available at: http://www.nmc-uk.org. Rafferty, M.A., (2000). Conceptual Model For Clinical Supervision In Nursing And Health Visiting Based Upon Winnicott's (1960) Theory Of The Parent/Infant Relationship. Journal of Psychiatric and Mental Health Nursing; 7 (2), p. 153. Rafferty, M., Jenkins, E., and Parke, S., (2003). Developing a Provisional Standard for Clinical Supervision in Nursing and Health Visiting: The Methodological Trail. Qualitative Health Research; 13: pp. 1432 - 1452. Rodenhauser, P., Rudisill, J.R., and Dvorak, R., (2000). Skills for Mentors and Protgs Applicable to Psychiatry. Academic Psychiatry; 24: pp. 14 - 27. Shanfield, S.B., Hetherly, V.V., and Matthews, K.L., (2001). Excellent Supervision: The Residents' Perspective. The Journal of Psychotherapy Practice and Research; 10, pp. 23-27. Sloan, G. and Watson, H., (2001). John Heron's Six-Category Intervention Analysis: Towards Understanding Interpersonal Relations And Progressing The Delivery Of Clinical Supervision For Mental Health Nursing In The United Kingdom. Journal of Advanced Nursing; 36 (2), pp. 206-214. Sloan, G., White, C., and Coit, F., (2000). Cognitive Therapy Supervision As A Framework For Clinical Supervision In Nursing: Using Structure To Guide Discovery. Journal of Advanced Nursing; 32 (3), pp. 515-524. Spence, C., Cantrell, J., Christie. I., and Samet, W., (2002). A Collaborative Approach To The Implementation Of Clinical Supervision. Journal of Nursing Management; 10 (2), 65. Teasdale, K., Brocklehurst, N., and Thom, N., (2001). Clinical Supervision And Support For Nurses: An Evaluation Study. Journal of Advanced Nursing; 33 (2), pp. 216-224. Van Ooijen, E., (2000). Clinical Supervision: A Practical Guide. Churchill Livingston, London. Walsh, K., Nicholson, J., Keough, C., Pridham, R., Kramer, M. and Jeffrey, J., (2003). Development Of A Group Model Of Clinical Supervision To Meet The Needs Of A Community Mental Health Nursing Team. International Journal of Nursing Practice; 9 (1), pp. 33-39. Winstanley J., (1999). Evaluation Of The Efficacy Of Clinical Supervision. Nursing Times, Clinical Monograph. Yegdich, T., (2000). Clinical supervision, Death, Heidegger and Freud come 'out of the sighs'. Journal of Advanced Nursing; 31 (4), 953-961. Read More