Skills of Clinical Supervision for Nurses - Research Paper Example

Skills of Clinical Supervision for Nurses Introduction The development and expansion of psychotherapy and counseling in the past twenty years and over has caused the emergence of debates on how people responsible for therapeutic duties can best be facilitated, supported, and monitored in the ever-growing trends of knowledge, awareness, and skills. Lawton and Feltham (2000) note that, in 1984, BAC (the British Association for Counseling) documented the principal Code of Ethics and Practice for Counselors, which indicated consistent supervision as the key agent for maintaining best and recommended standards of counseling practice. Because of the development of this code of ethics, keen attention has been given to this field. Major issues discussed have entailed the reasoning of who should be responsible as trainers or supervisors in a clinical setting. In addition, the training that the students and practitioners need to receive is another significant issue in the decision process of the appropriate code of ethics in the supervision. Other questions that should be addressed include, but are not limited to (1) what is the best supervision model that will help in achieving some of the best results? (2) To what degree is the supervision conducted on the counselors? And (3) are their specific roles of the supervisor and to whom is he or she accountable? The duty of Clinical Supervision in Relation to Psychological Therapy Because psychoanalysis is considered one of the ancient therapeutic alignments, it not surprising that the entire profession of counseling has applied a significant degree of supervision from its template. Several person-centered and psychodynamic schools still predominate – despite the fact that the ever-rising mental behavioral therapy – and generally significant emphasis is laid on supervision on the benefits of supervisory relationship, counter-transferential and transferential foci, and crucial relationship conditions, as well as on parallel process. More stress is also put on the wit of trainees particularly undergoing supervision from authorities (supervisors) who are comfortable or share similar theoretical orientation. In order to prevent unnecessary differences in clinical therapy, beginning counselors and person-centered supervisors should ideally involve person-centered supervisors, for example Gestalt supervisors and Gestalt counselors and so on. Feltham and Dryden (1994) confirm this fact. The development of cognitive behavior therapy, behavior therapy, the various transpersonal and humanistic replicas and more recently a range of narrative, systemic, electric, and integrative models, allows us to look at the issue of supervisee-supervisor adequacy in relation to the appropriate theoretical allegiance. Lawton and Feltham (2000) notes that: The existence of competing theoretical and clinical models also creates acute problems for supervisory assessment and interpretation…..therapists quite often receive contradictory supervisory interpretations of their clients’ behavior. It is not uncommon in group supervision for a supervisor and from several colleagues, each with their own idiosyncratic perspective and experience which can prove more perplexing than enlightening (Lawton and Feltham, 2000: 8). Clinical supervision is also an important facet in understanding how committed psychological therapists or can be supervised by diehard psychodynamic supervisors. Obviously, in several cases the common oppositions in supervisory extremes can be controlled by ensuring that clinical supervision is conducted putting in mind the interests of the supervisors and supervisees. However, with the rising development and acceptance of theoretical alignments, it appears statistically possible that the supervised group (particularly those residing outside major cities) will tend to face difficulty much more often in identifying suitable and experienced trainers or supervisors. Properly using the requirements of clinical supervision in psychological therapy helps in preventing mismatches related to orientations. Clinical supervision also expresses the concerns related to trainees’ decisions to practice personal therapy. This occurs because psychological therapy is one of the careers marked by self-determination as their highest ideals. However, limited protests often arise against the needed mandatory supervision in psychological therapy. Many counselors believe that incorporating clinical supervision during therapy practice aids in ensuring a fair application of the theories related to better client performance. There are organs such as BAC that describes the amount of time needed by the professionals in a supervision procedure. Prescriptive calls demand that counselors need to attend a minimum of one and a half hours every month for the supervision. It is the duty of different professional bodies in clinical supervision to stipulate the regulations of proficient behavior in psychological therapy. However, certain problems exist in association with the necessary supervision that ought to be created and addressed head-on. Different regions or nations have their own timeframe concerning the duration of supervision that a psychology therapy professional need to attain. For example, the United States does not require a lifetime counseling supervision for any professional in this field. Britain also indicates that every professional body should be responsible for monitoring the work of clinical psychologists, psychoanalysts, and psychotherapists. With these, it is important to question whether supervision has the potential dictate theoretical norms at the welfare of the client. The clinicians should question themselves whether their preferred psychology therapy approach is characterized by limited competency out of which their client need to be informed. Davenport (1992) warns that: Clinic-centered supervision, appealing as it may be, fails to meet the rigorous ethical and legal guidelines now required of counselor supervisors (Davenport, 1992, p. 231). Functions of Clinical Supervision Holloway (1995), Bordin (1983), Bernard & Goodyear (2009) explain that there are a number of definitions related to the actual meaning of supervision in clinical therapy. Milne (2009) provides a clear and more recent meaning capturing the fundamental elements of earlier supervision definitions and gives a vital description of the basic roles of supervision. Milner states that supervision refers to the formal establishment, by supervising authorities, of a training or education that is relationship-based. She further notes that the training and education should be work-focused and which evaluates, develops, supports, and manages the duties or responsibilities of the colleagues. Supervision is different from related actions such as therapy and mentoring, by using an evaluate element and by employing obligations in the practice. The basic techniques that supervisors employ are the supervisees’ corrective feedback on the performance, collaborative goal setting, and teaching. The goals of supervision should be restorative (for example, allowing for emotional processing and experiencing), formative (for example facilitating and maintaining the general effectiveness, competence, and capability of the supervisees), and normative (for example, quality control and case management issues). The fundamental objective of the supervising authority is to help the client achieve positive results from the services of clinical psychology. To that effect, clinical supervision needs to ensure that the trainees of clinical psychology can practice effectively and safely. Additionally, aspirations are also available for supervising authorities to construct upon the strengths or force that supervisees instill on the process. The normative responsibility of clinical supervision is an important one based on the statements by registration and professional bodies. This normative responsibility includes two main aspects. The first aspect (indicated APS-Australian Psychological Society ethical guidelines, 2003, Pg. 5), supervisors are charged with the duty of ensuring that supervisee practices during training sessions are conducted considering the benefits that the clinic clients will ultimately achieve after the termination or end of the psychological therapy in the clinical setting. Effective clinical supervision is also aimed at ensuring that the practitioners adhere to the professional practice standards. Concerns that might arise from the notion or belief by the supervisors that their supervisees are breaching one or several standards of ethical practices in psychology therapy, alarm should be raised to the national registration board and the issue addressed accordingly. The Australian Psychological Society (2003) further notes that the major duty of the supervising authority is “to make a judgment about the competence of their supervisee….and whether they believe this person is sufficiently prepared to enter the profession as a colleague” (Pg. 4). Current ‘National Registration Rules’ gives the supervisors the final responsibility as the determinants of whether the supervisee has achieved the needed core competencies in relation to being as one of the competent psychologist. That is, supervisors are known as the gatekeepers charged with the duty of making sure that trainees are capable of practicing clinical psychology as a competent profession. Brief summary of the functions of clinical supervision in psychology therapy: Duties and Goals of Clinical Supervision Duty Immediate goals Final/Ultimate goals Normative Quality control, monitoring, and case management Evaluate the performance of supervisee Ensuring that the therapy delivery of a trainee is operative, decent and safe Enhance current benefits of the client Analyze sufficiency of the competence of the supervisee Define the fitness of the supervisee for psychology therapy practice Ensure that the trainee/supervisee has the ability to safely, effectively, and independently administer therapy to the client Restorative Emotional processing and support Augmenting operative professional self-care Grow trainee’s professional identity Increase trainee’s professional flexibility Improve trainee’s ability to practice psychological therapy in ways that safeguards her or his own health and prevention of burnout Formative Develop trainee’s knowledge and skills Assist in clinical decision making Enhance trainee’s self-evaluation Develop sufficient repertoire of therapy skills and knowledge and skills Improve skills of self-reflection Create long-term self-educational and commitment strategies to promote evidence-based and effective practice Models/Techniques of Clinical Supervision, Evidence Bases and their Impact on Therapy Practice Several literatures deal with models that can be applied in effective administration of clinical supervision. In the selection of the appropriate model, it is important to critically evaluate and review some of common models. The following are some of the objectives that can be used in clinical supervision to understand the various models in therapy administration: (1) educative or formative model, (2) supportive or restorative model, and (3) managerial or normative model. Each model has their merits and demerits concerning the setting and scale with which they are employed. Supervision models based on psychotherapy Clinical supervision began as the practice of receiving, assisting, and observing feedback. In this manner, clinical supervision in psychological therapy administration follows the techniques and framework of the particular psychotherapy model or theory being practices by the supervisee and supervisor (Milne, 1998, Pg. 201). With the rising need for particular supervisory interventions developed in their importance, supervisory theories developed within the available psychotherapy models/theories to address the identified need. Psychotherapy-based theories of clinical supervision tend to feel like a basic extension of the psychological therapy itself. Falender & Shafaanske (2008) stated that theoretical alignment informs the selection and observation of clinical information for debate in supervision in addition to the relevance and meaning of those data. Therefore, there is the presence of a continuous flow of technique, focus, and terminology from the counseling programs to the clinical supervision session. The available examples of particular supervision based on psychotherapy models are discussed below. Learners interested in understanding more about particular supervision based on psychotherapy theories should be referred to different references or literatures for further knowledge. Clinical Supervision models Psychodynamic Model to Supervision As indicated in the previous section (stated above), psychodynamic clinical supervision utilizes clinical data related go the theoretical orientation, for example, countertransference, transference, defense mechanisms, and affective reactions among others. Researchers categorize psychodynamic clinical supervision into three main categories: supervisory-matrix-centered, supervisee-centered, and patient-centered. Patient-centered category started with Freud and it focuses on the session of supervision on the patient’s behaviors and presentation. The role of the supervisor is didactic, that is, it is in accordance with the objective of aiding the supervisee to learn and tackle the client’s material. It is indicated that the supervisor appears as the professional who is not involved, but with the necessary skills and knowledge to help the supervisee, thus providing support to the considerable authority. Because much focus is put on the client, and not on the trainee or supervisory procedure, insignificant disagreements occur between the supervisee and supervisor, as long as both define the theoretical orientation similarly. This absence of stress or conflict in the supervisory processes tends to reduce the anxiety of the supervisee, making it easy to learn. Consequently, if disagreements were to occur in the process of using this theory, there is the occurrence of possible impediment to the supervision since there will be no direct way of dealing with the problem (Wheeler, 2012, Pg. 29). Psychodynamic clinical supervision that is supervisee-centered were accepted during 1950s. They focused on the process and content of experience the supervisee gained from the counseling process. Counseling processes are focused on the trainee’s learning problems, anxieties, and resistances. The role of the supervisor is to act as an uninvolved professional while maintaining authority over the supervisee since attention is directed towards the supervisee’s psychology. Clinical supervision processes using this technique are less experiential than they are didactic. The supervisory-matrix-centered model provides more component in the supervision process since it not only caters for the client and supervisee material, but also outlines the evaluation of the relationship between the supervisee and the supervisor. In this case, the role of the trainer is no longer that of an uninvolved professional. Feminist Model/Approach of Clinical Supervision Feminist hypothesis affirms that this individual can be political; that is, a good individual’s encounters are generally reflective of society’s institutionalized thought patterns in addition to prices (Feminist Therapy Start, 1999, Pg. 55). Feminist practitioners, then, contextualize your client’s –and his or her own—experiences inside the globe where that they live, often redefining thought sickness because of oppressive values in addition to behaviors (Feminist Therapy Start; Haynes, Corey, & Moulton, 2003, Pg. 74). Feminist treatment is additionally identified as interactional, variable, and gender-fair in addition to the aligned life span (Haynes, Corey, & Moulton). The particular Ethical Tips with regard to Feminist Experienced counselors (Feminist Therapy Institute, 1999, Pg. 104) stresses the need with regard to practitioners to be able to admit strength differentials in the client-counselor partnership in addition to work to be able to model efficient using individual, structural, in addition to institutional strength. Although Tips will not particularly deal with your supervisee-supervisor partnership, it could be believed that these identical tenets apply at this specific other partnership. That is certainly, your supervisor-supervisee partnership aims being egalitarian on the degree possible, while using supervisor-sustaining focus on your empowerment on the supervisee. Cognitive-Behavioral Theory Similar to different psychotherapy-based ways of approach, a vital task of a cognitive-behavioral supervisor would be to show the particular approaches in the theoretical positioning. Cognitive-behavioral theory uses known cognitions and behaviors—particularly in the supervisee’s skilled personality and his/her reaction to the customer (Hayes, Corey, & Moulton, 2003, Pg. 34). Cognitive-behavioral approaches found in literature include placing an agenda regarding direction consultations, bridging from preceding consultations, setting groundwork to the supervisee, and capsule summaries with the manager. Person-Centered Hypothesis Carl Rogers formulated person-centered therapies all around the fact that the customer will be able to effectively take care of lifetime difficulties devoid of decryption and direction of the psychologist (Haynes, Corey, & Moulton, 2003, Pg. 61). Within the very same abnormal vein, person-centered hypothesis considers the supervisee has the means to help effectively develop to be a psychologist. The actual manager is not seen as a specialist with this model, but rather acts as a “collaborator” with the supervisee. The actual supervisor’s function would be to provide an atmosphere that supervisee is usually offered to his/her knowledge and completely involved with the patient (Lambers, 2000, Pg. 112). In person-centered therapies, patterns of thought and specific characteristics in clinical psychology therapy, in addition to the products mandated for particular clients, are categorized as the basic determinants of the ultimate therapy results. (Haynes, Corey, & Moulton, 2003, Pg. 75). Person-centered direction explores this specific tenet as well, depending intensely within the supervisor-supervisee connection to help facilitate efficient understanding and development within model. Ronnestad and Skovholt’s Design This type of theory is dependent on a longitudinal qualitative study conducted through choosing 100 counselors/therapists, which range throughout the encounter (at the start of the actual study) from graduate learners to be able to work together with authorities in over twenty- five years in relation to the encounter (Skovholt & Ronnestad, 1992, Pg. 102). The two researchers analyzed the resulting facts using three means: creating a phase design, style ingredients, along with a skilled style of development and stagnation (Ronnestad & Skovholt, 2003, Pg. 48). Using the newest approach to this theory (model), the actual type contains six to eight periods out of which three are connected to development. The first three periods (Set Tool, Student Step, and the Superior Student Step) overlap using the numbers of the actual IDM. The next three periods (Amateur Professional Step, Encountered Professional Step, and the Senior Professional Step) are self-explanatory with regard to the actual comparative incident of the cycle concerning the actual counselor’s session. Integrated Development Style Among the most investigated developing models of psychotherapy supervision theories is the Integrated Developmental Model (IDM) developed by Stoltenberg (1981). Delworth (1987), Stoltenberg, McNeill, & Delworth (1998) and Falender & Shafranske, (2004) affirm that the actual IDM details three levels of professional progress: Levels 1-supervisees are likely to be entry-level individuals who will be elevated in determination, anxiousness, in addition to fear of assessment; Level 2- only two supervisees have reached mid-level and experience fluctuating confidence and drive, typically back linking their particular mood in order to succeed in helping the clients; and Level 3-supervisees who are essentially safeguarded, and possessing secure self-drive; get appropriate consideration based on their objectivity. Risk Management and Confidentiality in Clinical Supervision To avoid risks resulting from competency, clinical work supervisors need to participate and stay competent in the continuous process of certification and education in the supervision process. Supervisors need to understand development and growth in clinical supervision practice and have the capacity to integrate evidence-based supervision with the guiding process. They should also be aware of their capabilities and function within the degree of their performance. When there is familiarity with the areas of practice, supervisors need to obtain help or refer their supervisees to appropriate sources for consultation (Bond, 2010, Pg. 21). Supervisors also need to consider signing off in terms of submitting their reimbursement claims to the responsible authorities for the services they have performed. It is considered fraudulent when a supervisee signs off on services he or she is ineligible to seek compensation for. Supervisee and supervisors need to be informed of the regulations and statutes addressing the issue at hand in their own jurisdictions (Driscoll, 2000, Pg. 18). Supervisors are charged with the direct liability for the quality of services they give to their supervisees. For example, they may be liable when the supervisees give services that are detrimental to the lives of the clients. The actual supervisory relationship was made upon trust, discretion, help, as well as empathic ordeals. Some other qualities inherent in the supervisory relationship include useful suggestions, safe practices, admiration, as well as self- care (Hess, 1980, Pg. 11). The actual criteria pertaining to societal function guidance should be utilized in partnership with skilled common sense as well as an exclusive foundation on which a choice is created. Managers should acquaint independently while using the supervisory specifications associated with regulatory as well as accreditation physiques in which they command their particular geographic region and/or functional environment. Direction makes sure that supervisees acquire advanced expertise in order that their knowledge as well as abilities is usually placed on patient populations in an ethical as well as skilled manner (Watkins, 1997, Pg. 35). A number of elements of skills, as well as their application to help clients, may always be converted in the supervisory method. Direction delivers assistance as well as promotes material help to the inspector (supervisor), supervisee and the patient (client). While using the growing target of interdisciplinary practice, societal individuals might be closely watched by way of employing specialization of any unique control. While this is suitable inside workforce as well as system situation, societal individuals need to seek watch as well as consultation through an additional societal staff member with regard to specific societal work practices and problems (Edwards et al., 2005, Pg. 410). In addition, a new societal staff member delivering supervision to an individual in an additional control needs to relate the individual’s supervisee to the patient in their own career pertaining to practice-specific supervision and consultation. Societal work administrators need to comply with the particular clinical supervision standards. This pertains to therapy skills inside the clinic and specialized expertise. The practitioner should also be familiar with the traditions of the client population supported by the supervisee. Administrators can converse information about varied client groupings to help supervisees as well as aid them to work with suitable methodological approaches, expertise, as well as strategies (Sloan, White & Coit, 2000, Pg. 517). These are in line with the knowledge of the particular position connected with traditions within the helping procedure. The particular supervisor responsible for the successful training of a new supervisee in psychological therapy should use a unique ethnical backdrop using computer skills and the traditions of the clinical work practice. Key causes of information occasionally include the particular supervisee as well as other professionals accustomed to the particular supervisee’s ethnical area. Throughout instances where a supervisee is being trained by several men or women supervisors, it is a good idea to conduct the training using experience gained from contractual agreement or even memorandum connected with understanding delineation of different managerial duties (Flavey, 2002, Pg. 30). The particular function of each manager includes details of the relationships, information-sharing, points, in addition to how clashes are going to be resolved. In the event that simply no agreement prevails, the particular clinical supervisor could possibly have one more way out. If the environment allows, an outside third- party could possibly be used to help resolve the particular clash. Supervisors must ensure that each client information be held individually, in addition to keeping their privacy as required by law (Hays, and Iwamasa, 2006 Pg. 7). Supervisees need to inform the client throughout the first therapy procedure (interview) of the information that is personal. There are contribution in the interview sessions that are considered personal and in terms of the relationship between the supervisee and the client. Superiors also provide a great responsibility to shield the personal information, in addition to keeping the supervisory method secret. It is required that only the supervisory board has the right to access the therapy procedure that the supervisee employed in the process. The information taken from the procedure is vital in stating disciplinary actions on the conduct of the supervisee (Pretorius, 2006, Pg. 419). Schedule required for the particular oversight period must also be validated. There are a number of challenges connected to identifying the correct intention for a general clinical supervision oversight. Assigning new duties to the supervisee is also a major risk in the success of the supervisory work. If the supervisee is spending money on the particular solutions, he or she can write off the particular supervisor, particularly if arguments or even clashes crop up. The supervisee also can pin the consequence on the particular supervisor when there is malfunction within the licensing method. Furthermore, the particular manager may experience case management clashes relating to the supervisee and the agency (Cassedy, 2010, Pg. 5). Advancement of a contractual agreement with one or several interpersonal member of staff, the particular manager, and the agency is vital in the prevention of complications within the supervisory relationship. An agreement needs to delineate the particular agency’s specialist in addition to giving the supervisee the opportunity or mandate to administer specialized psychological therapy in the clinic. Examination responsibilities, regular composed studies, in addition to concerns connected with confidentiality must also be included in the agreement (Milne & James, 2000, Pg. 123). Bottom of FormConclusion Effective social work practice in the clinic involves more than the direct interventions and services skills with particular clients. Effectiveness of the practice of clinical supervision also entails the ability to affect the community and organizational setting of the provision of services directly related to different client groups. The direct relation is vital in ensuring that gaps are filled, the cruel social conditions are ameliorated, and social policies are improved. Clinical supervision is modeled to aid in developing the skills and knowledge to perform on behalf of a wide range of customers in using indirect methods that eventually improve the value of clients’ well-being and direct services. References 1. Top of Form AUSTRALIAN PSYCHOLOGICAL SOCIETY. (2003). APS ethical guidelines: Guidelines on supervision [electronic version], 1–7. Retrieved May 15, 2014, from http:// www.psychology.org.au/Assets/Files/guidelines_on_supervision.pdf BERNARD, J. M., & Goodyear, R. K. (2009). Fundamentals of clinical supervision (4 th ed.). Needham Heights, MA: Allyn & Bacon. BOND, M. (2010). Skills of clinical supervision for nurses: a practical guide for supervisees, clinical supervisors and managers. Maidenhead; New York: Open University Press. BORDIN, E. S. (1983). ‘A working alliance based model of supervision,’ Counseling Psychologist, 11 (1): 35-42. CASSEDY, P. (2010). First steps in clinical supervision: a guide for healthcare professionals. 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