FOUNDATIONS TO SUPERVISION - WA Health · 2012-01-12 · • Monitoring professional competencies,...

FOUNDATIONS TO SUPERVISION

Compiled by WA Country Health Service Combined Universities Centre for Rural Health 2009

The following learning package has been designed to provide you, the practitioner, with the necessary information for a flexible learning opportunity that will enhance your current skills and ongoing professional development. Advantages of Learning Package includes: • Learning is self paced and can occur at a time that is convenient to the individual • Placing responsibility for the learning on the learner • It allows individuals to build on existing knowledge The information, opinions, suggestions and ideas contained in this package are based on materials, believed to be accurate but not infallible. While written in good faith, there is no responsibility or liability for any loss or damage caused directly or indirectly from actions taken by participants. While the information provided follows acceptable professional standards and all effort has been made to render this material free from omission or error, it should not be seen as professional advice specific to any particular situation, problem or person, and further advice should be sought for individual situations where necessary.

Acknowledgements

We gratefully acknowledge the contributions of the following people in the development of this package: Ivan Lin, Combined Universities Centre for Rural Health Angela Durey, Combined Universities Centre for Rural Health Mark Petrich, WA Country Health Service Suzanne Spitz, WA Country Health Service Special acknowledgement is made to Dr Richard Ladyshwesky Curtin University of Technology who has generously provided access to intellectual property and materials relating to clinical supervision.

Acknowledgements are also provided to University schools/departments of Curtin University of Technology and Edith Cowan University who contributed to the development of this resource.

Use of this resource by a range of organisations and universities is welcome and encouraged so long as appropriate acknowledgement is provided. Feedback regarding the improvement of this tool is welcome.

Developed: February 2009 Review: February 2010

Foundat ions to Superv i s ion Page 2 WA Country Hea l th Serv ice & Combined Un iver s i t ies Cent re for Rura l Hea lth (Feb 09)

Contents

TScope of Package .........................................................................................................4 T

TSupervision in Health Provision........................................................................................5 T

1.0 Introduction.......................................................................................................7

1.1 Introduction.................................................................................................8 1.2 Defining Supervision .......................................................................................8 1.3 Purpose of Supervision ....................................................................................9 1.4 Principles of Supervision ..................................................................................9 1.5 Summary................................................................................................... 11

2.0 The Supervisor Relationship................................................................................. 12

2.1 Introduction............................................................................................... 13 2.2 Factors Influencing the Relationship.................................................................. 13 2.4 Trust ....................................................................................................... 15 2.5 Communication........................................................................................... 15 2.6 Clinical Teaching & Education…………………………………………………………………………………………………19 2.7 Supervisee Stages ......................................................................................... 19 2.8 Supervisory Style.......................................................................................... 19 2.9 Rights and Responsibilities .............................................................................. 20 2.10 Empowered Supervisees ................................................................................ 21 2.11 Summary ................................................................................................... 21

3.0 SUPERVISORY PROCESS ........................................................................................ 22 3.1 Introduction………… …………………………………………………………………………………………………………………24

3.2 Stages of supervision .................................................................................... 23 3.3 Contracting & Planning.................................................................................. 23 3.4 Assessment & Evaluation................................................................................ 25 3.5 Monitoring and Follow-up............................................................................... 27 3.6 Termination............................................................................................... 27 3.7 Summary................................................................................................... 27

4.0 EVALUATING SUPERVISION ................................................................................... 28

4.1 Introduction................................................................................................ 29 4.2 Types of Evaluation....................................................................................... 29 4.3 Evaluation Questions ..................................................................................... 29 4.4 Evaluation Tools........................................................................................... 30 4.5 Troubleshooting ........................................................................................... 30 4.5 Summary ................................................................................................... 30

5.0 Summary......................................................................................................... 31

6.0 References & Further Reading.............................................................................. 33

Appendix One: Strategies to promote Adult Based Learning in a Clinical Context ......................... 35 Appendix Two: Learning Styles ..................................................................................... 36 Appendix Three: Tips for Giving Feedback ........................................................................ 38 Appendix Four: Tips for Receiving Feedback ..................................................................... 39 Appendix Five: Deciding the Type of Feedback to Provide: An Intervention Framework................. 40 Appendix Six: Providing Constructive Feedback.................................................................. 41 Appendix Seven: Be an Empowered Supervisee .................................................................. 42 Appendix Eight: Five Principles of Goal Setting .................................................................. 43 Appendix Nine: Supervision Contract .............................................................................. 44 Appendix Ten: Evaluating a Supervision Session ................................................................. 45 Appendix Eleven: Qualities of an Effective Supervisor.......................................................... 46 Appendix Twelve: Trouble Shooting ............................................................................... 47


Scope of Package This package is aimed at all health professionals who provide or receive supervision responsibilities within their clinical duties. This may include the supervision relationships with unregulated workers, junior staff, peers or students. The term ‘clinical’ is utilised in this document to refer to supervision undertaken in the delivery of health services. Whilst this may not translate for all health professions (e.g. public health), the content of this package is applicable to a range of health settings. For the purpose of this document the term supervision will be utilised to describe foundation skills relevant to a range of supervisory relationships, including precepting.

Aim

This learning package has been compiled to assist staff in gaining the necessary theoretical knowledge and skills to participate in supervision in a clinical context as either a supervisee or a supervisor.

Objectives

Outline the expected knowledge gain and outcomes of the program. Understand the purpose of supervision and how it relates to other developmental

relationships. Be more familiar with adult education principles and learning styles Describe factors influencing a successful supervisor and supervisee relationships Ability to plan and develop supervisory contracts and process Evaluate own and other supervision skills and process.

Icons

Throughout the package you will see a number of different icons. When you come across them you will be prompted to complete the relevant task. A key to all the icons in this package is provided below.

Reading

Written Activity

Reflection

Discussion

Toolbox


Supervision in Health Provision The WA Country Health Service (WACHS) is committed to creating an environment that supports learning and development to ensure staff maintain and improve their skills and competency. Supervision is an important part of achieving safe, high quality care and service and a satisfied workforce

Terminology A range of terminology can be used to describe professional developmental relationships. Supervision: literally meaning “over see”, developed from industry, where technical skill and task completion was supervised, often by a person with recognised more experience or expertise. Preceptor: Nurses use the term preceptor to describe the teaching and supervision relationships between nurse and student, or experienced nurse and less experienced nurse. For the purpose of this introductory training module, the term preceptor and clinical supervisor/supervision are synonymous. Clinical supervision: Clinical supervision describes a formal professional development and support relationship between two or more people, for the purpose of improving safety and quality of care to clients through professional development. Mentoring: Classical or traditional mentoring has been a recognised relationship for centuries, characterised as a lifelong relationship between an older, more experienced mentor providing support to a younger, less experienced protégé or mentee. Coaching: Coaching is often a term applied to specific skill or task development, and hence is considered a short-term relationship focused on a particular goal. Performance Development: Performance development is a tool for rewarding, encouraging, supporting and developing all employees. The performance development process comprises regular reviews within a yearly cycle (Department of Health). Performance Management: Performance management is a formal process applied in circumstances where problems with performance exist, such as an employee performing at a substandard level. **For the purpose of this document the term supervision will be utilised to describe foundation skills relevant to a range of supervisory relationships, including precepting.

Supervision, Learning and Development All health professionals in WACHS will undertake some form of supervision within their role. Supervisory relationships may include those with peers, managers, less experienced health professionals, support workers, and students. Well-structured and supported supervision can improve work practice and client outcomes as well as reducing burnout in health care professionals. It is part of continuous professional development for health practitioners, and


contributes to a lifelong learning process. The WACHS policy on learning and development can be viewed at http://wachs.health.wa.gov.au/default.asp?rid=7&pid=2619

A Tiered Approach to Clinical Supervision Training In this program, a series of training modules have been developed to increase skills and knowledge in supervision. The supervision modules are designed as self-directed learning packages, but will be available as videoconferences throughout the year. A facilitator can also deliver the modules locally. Group involvement in the learning process can be of additional value for participants. It is expected that each module will take 90 minutes to 120 minutes to complete. Modules 1. Foundations to Supervision This module provides an overview of core skills, terminology and processes that underlie all clinical supervision relationships. This module targets both supervisors and supervisees – recognising the two-way relationship of supervision. This module is a pre-requisite to all subsequent modules and is applicable across a range of supervision contexts (e.g. supervision with students, peers and managers). 2. Context Specific Supervision These modules develop skills and processes required for a specific clinical context. Contexts may include: Supervision of Students Supervision of Unregulated Workers (e.g. allied health assistants) Supervision of Health Professionals

3. Discipline Specific Supervision These modules develop skills and processes required for a specific discipline. This is especially pertinent for the provision of clinical supervision to students, where universities have established procedures and tools for assessment and evaluation.

Foundations Level

Student Support Workers Professional

Profession Specific


http://wachs.health.wa.gov.au/default.asp?rid=7&pid=2619

1.0 Introduction

Key Learning’s Supervision involves three critical components

o Relationship o Process o Evaluation

Supervision is undertaken in many forms (students, peers, subordinate), can include a

range of terminology (supervisor, preceptor) The purpose of supervision is to:

o Ensure safety and best quality services for clients. o Enhance personal and professional development and support. o Monitor professional competencies, standards and practice

The function of supervision includes

o Restorative/support o Formative/learning o Normative/accountability

Supervision must be grounded in the principles of adult learning

o Adults are goal-oriented. o Adults are relevancy-oriented. o Adults are practical. They like to be able to apply their knowledge. o Adult learners like to be respected. They like to be treated as equals, to voice

their own opinions and to have a role in directing their own learning. The learning styles of both the supervisor and supervisee must be considered.


1.1 Introduction Foundations to Supervision provides an overview of core knowledge, skills, terminology and processes that underlie all clinical supervision/preceptorship relationships. This module is a pre-requisite to all subsequent modules and targets both supervisors and supervisees – recognising the two-way relationship of supervision. Key elements of supervision addressed in the module include: Relationships: supervision requires a relationship to be formed between supervisor and

supervisee. Process: how supervision relationships are initiated, developed and completed. Evaluation: an opportunity to reflect on factors facilitating or blocking an effective

supervision relationship. Evaluation, be it formal or informal, aims to ensure the quality for supervision for all parties involved.

1.2 Defining Supervision Supervision literally means to oversee. There are many forms of supervision that occur, formal and informal. There are many examples of this broader version of supervision in health care: • Nurse preceptor supervises new graduates and students • Therapist supervises the client’s performance • Radiologist supervises the clients following instructions for x-ray • Administrative staff supervise peers in the use of a new statistics package • Speech Pathologist supervises a therapy assistant conducting a therapy program. • A line manager supervises staff performance of duties • Physiotherapist supervises a student on clinical placement. Supervision in Health Care In the health care environment, the ultimate objective of supervision is to deliver the best possible service to clients, in accordance with agency policies and procedures. Inextricably tied to this objective is a second objective of professional development and growth of the supervisee. Key elements of supervision include: • Ensuring safety and best quality services for clients. • Enhancing personal and professional development and support. • Monitoring professional competencies, standards and practice.

Carroll & Gilbert (2005)


1.3 Purpose of Supervision Supervision is a critical aspect of both service quality and safety and staff learning and development. Supervision can serve a number of purposes including:

Restorative/Support Formative/Learning Normative/Accountability

• Supports clinical effort • Reduces feelings of

isolation and develops a sense of ongoing collegial/professional support

• Validates ideas, feelings, and experiences.

• Minimises professional uncertainty.

• Provides a forum for discussion of challenging client or client groups.

• Offers opportunities to explore different perspectives on experiences.

• Assists in decision-making and problem solving.

• Supports work-life balance, and professional quality of life.

• Focuses on the awareness

and development of skills and abilities.

• Addresses blind spots in practice, attitudes and knowledge.

• Develops realistic self-evaluation and reflection skills.

• Negotiates goals and monitors achievement

• Offers feedback on practice

• Teaches and demonstrates clinical techniques.

• Explains rationale/theory of actions.

• Supports practitioners to be accountable for their own practice and development

• Ensures client safety,

high quality service provision and ethical behaviour.

• Ensure support for evidence-based health care.

• Defines and clarifies performance standards.

• Facilitates innovative practice and discussion of practice issues.

• Ensures compliance with policy and procedures.

• Promotes a high standard of work.

Alsop, A. & Ryan, S. (1996)

1.4 Principles of Supervision 1.4.1 Adult Learning Supervisory relationships are between two adults requires understanding of adult learning principles into supervisory practice. The supervisee has typically followed a process to get where they are at in the present time. They have had to meet standards of behaviour and practice and perform at required levels and work through problems. They bring a variety of experiences with them. Adult learners are autonomous and self-directed. They like to direct their own learning, be actively involved in learning and have the flexibility to work around their specific interests and personal goals. Adults also bring life experiences and knowledge to learning experiences. This may include work-related activities, family responsibilities, and previous education. Some key features of adult learning include:


Adults are goal-oriented. Adults are relevancy-oriented. Adults are practical. They like to be able to apply their knowledge. Adult learners like to be respected. They like to be treated as equals, to voice their own

opinions and to have a role in directing their own learning.

Toolbox See appendix one for strategies to promote adult learning in a clinical

context.

Further Reading Lake, F and Ryan, G (2004). Teaching on the run tips 2: Educational

guides for teaching in a clinical setting, MJA 180 (10): 527-528 available at www.mja.com.au/public/issues/180_10_170504/lak10885_fm.html

Adult Learning Australia www.ala.asn.au 1.4.2 Learning Styles There are many theories about how people learn (their ‘learning style’). What is clear is that different people learn in different ways. In supervisory relationships it is important to understand your learning style (both as a supervisor and supervisee) to maximise the learning component of the relationship. There are many different ways of learning in the health care setting. Try and select learning methods best suited to the supervisee. Examples of learning methods include: Learning by talking to clients Reflecting on past clinical experiences Comparing notes Keeping journals and diaries Using problem solving strategies and devices Mind maps/Decision trees Learning on the job Trial and error learning Changing one’s role

Activity: What learning style are you? Complete the Index of Learning Styles Questionnaire www.engr.ncsu.edu/learningstyles/ilsweb.html. What learning style are you? How does this impact on you as a supervisor and/or a supervisee?

Toolbox See Appendix two provides further information of the learning styles

and how to adapt learning in the clinical environment.


http://www.mja.com.au/public/issues/180_10_170504/lak10885_fm.html

http://www.ala.asn.au/

http://www.engr.ncsu.edu/learningstyles/ilsweb.html

Further Reading See Appendix two provides further information of the learning styles

proposed by Honey and Mumford’s (1986). Overview of Learning Styles & Strategies www4.ncsu.edu/unity/lockers/users/f/felder/public/ILSdir/styles.ht

m JCU Study Skills Online – Learning Styles www.jcu.edu.au/studying/services/studyskills/learningst/

1.5 Summary Supervision is an important component in ensuring and improving the quality and safety of health services and as a continuing development strategy. Health professionals engage in a range of supervisory relationships throughout their career, both as a supervisee and a supervisor. Good supervision is grounded in principles of adult learning and is sensitive to the different ways in which people learn.


http://www4.ncsu.edu/unity/lockers/users/f/felder/public/ILSdir/styles.htm

http://www4.ncsu.edu/unity/lockers/users/f/felder/public/ILSdir/styles.htm

http://www.jcu.edu.au/studying/services/studyskills/learningst/

2.0 The Supervisor Relationship

.

Key Learning’s The supervisor/supervisee relationship is a critical aspect of supervision.

It is important to consider factors affecting relationships such as gender, culture, power

differential, and relationship boundaries. Trust underpins all effective supervisory relationships.

Feedback aims to facilitate learning and help change behaviour, and is one of the most

important skills required by supervisees and supervisors. Feedback is:

o Specific o Factual o Descriptive o Constructive o Clearly understood o Timed to be most useful o Sensitive to the learner o Directed at the behaviour, NOT the person

Supervision involves creating an open communication environment, which encourages

self-reflection by the supervisee and supervisor. Questioning provides a good means of facilitating self-reflection.

Conflict is a natural part of any relationships, but it is important to recognise and manage

conflict early. Supervision styles should be tailored to the individual needs of the supervisee.

Supervisee stages and needs may depend on the supervisee’s requirements, knowledge, skills, development, expectations or the specifics of the situation.


2.1 Introduction Developing a purposeful supervisor/supervisee relationship is critical and one that enable communication and trust. Establishing shared understandings in regard to the roles, responsibilities, and boundaries of supervision is critical. A number of principles, models and theories are available in the literature to assist the development and growth of relationships. Some of these will be outlined in this module but you are encouraged to read further areas of interest or relevance to you. Extension and further development of these relationship skills will be available in successive supervision modules. Key components of a supervisory relationship may include: Recognising factors affecting relationships such as gender, culture, perception of power and

professional and personal boundaries which can become blurred in small rural locations Communication and trust Basic understanding of adult learning principles and learning styles Adult personality types and influence on relationships and learning Common roles and responsibilities of supervisors and supervisees Effective styles of supervision for developmental stages Negotiation and conflict resolution skills

2.2 Factors Influencing the Relationship 2.2.1 Culture Cultural factors such as the family environment and neighbourhood in which you grew up, ethnic background, age and gender expectations can influence behaviour in the supervisor-supervisee relationship. Unspoken or unexamined assumptions of our responses to racial and cultural differences impact on the supervision process. Examining your own cultural beliefs and practices and how they intersect with the beliefs and practices of those from culturally and linguistically diverse backgrounds is necessary for culturally proficient practice. Although a supervisor’s and supervisee’s attitudes about diversity, race, culture, gender, sexuality and spirituality may be difficult to assess, it is critical to create a safe space to increase awareness and discuss differences early in order to build a healthy professional relationship. By being aware of cultural behaviour patterns, supervisors and supervisees can modify the way in which they interact.

Activity: Answer the question below to reflect on your cultural beliefs? 1. How do you greet people? Do you shake hands? Kiss? Hug? Rub noses?

Smile broadly? Shout out an informal 'G'day!'? Bow? 2. Do you nod or shake your head to say yes? 3. How close do you stand to people when you're talking with them? 4. Is giving a gift to a senior official in the University bribery or a token

of appreciation? 5. Do you open gifts in front of the giver or do you put them aside for

later? 6. Do you look people in the eye when you talk to them? 7. Do you say you don't understand or would that involve too great a loss

of face for you or the person who is talking to you?


8. Do you call people by their first name or by their titles? 9. What constitutes acceptable touching in a social context? 10. Do you point out errors of fact in conversations with your students?

colleagues? managers? 11. How do you elicit comment from someone? 12. Do you interrupt people when they are talking? Take some time to reflect on your responses and how your cultural beliefs may influence supervisory relationships?

Queensland University of Technology, Supervisor Solutions

2.2.2 Power Differential The supervisor’s authority, knowledge base and professional experience in the supervision context reflect an unequal power relationship with the supervisee. As a result, some supervisees may feel uncomfortable expressing disagreement, voicing their own opinions or asking for help from their supervisors in situations where the power differential is great. One way to address this issue is for the supervisor to be familiar with the principles behind adult learning such as the supervisee’s need for autonomy, self-direction and respect. Supervisors can facilitate learning by creating an environment at the beginning of the relationship where a supervisee feels comfortable discussing role expectations, learning outcomes and any difficulties they are experiencing. 2.3.3 Gender Men and women have different communication styles. The stereotype is that men's communication is characterised by competition, a focus on hierarchy, communication of information and facts rather than feelings, abrupt changes in topic, confrontational style with strongly expressed opinions and the use of silence as self-defence. In contrast, the stereotypical female communication style is characterised by cooperation, lateral organisation, concern for harmony, self-disclosure, self-deprecatory humour, gentle shifts of topic that acknowledge previous speakers, taking turns in speaking and using silence to allow others to speak (Deakins 1992, cited in Conrad and Phillips 1996). While these styles are stereotypes and by no means universal, they do indicate that different communication styles can enable or block effective communication.

Discussion: Gender Have you supervised or been supervised by someone of the opposite gender? Did it have an impact on your supervisory relationship? If so, how?


2.3.4 Relationship Boundaries Establishing professional relationships is especially challenging in the rural and remote context where work-home life boundaries can easily become blurred. This is evident not only in the blurring of social/professional but also of intra-professional boundaries. To add complexity, supervisors may carry dual (or multiple) roles such as supervisor, line manager, educator and mentor. It is important that supervisor and supervisee discuss and define the relationship and its boundaries.

Reflection: Where do your boundaries lie in the supervisory relationship? Consider the following questions: Would you go to the pub with your supervisee/supervisor? Would you give your supervisee/supervisor your home phone number?

What about your mobile phone number? Would you invite your supervisee/supervisor home for dinner with your

family? What about a weekend barbeque with other colleagues? Do you have similar boundaries with all your supervisees or are there

differences among supervisees? How do you decide on boundaries with your supervisees?

Are your boundaries flexible, based on compatibility or some other criterion, or do you have a set of guidelines for relationships with supervisees/supervisors from which you never waver?

Can you articulate your views on professional and personal relationships with your supervisees/supervisor?

2.4 Trust Trust is a crucial element of quality relationships in the workplace and is often the ‘’glue’ that holds people together. In the workplace we associate trust with perceptions of competence, feeling safe, good will towards others, self-disclosure, the availability of resources and the importance of reflective practice. Trust is an inherent component of clinical supervision, and, whilst grounded in respect and demonstration of clinical competence, can also be built by: Emotional support (eg concern, listening) Appraisal support (eg affirmation, feedback) Informational support (eg suggestions, directives), Instrumental support (eg money, labour, time)

Trust can be undermined by factors such as blurred professional boundaries, differing socioeconomic status, culturally and linguistically diverse backgrounds, and power differentials. Trust can be built by acceptance of difference, respect and inclusion.

2.5 Communication

2.5.1 Giving & Receiving Feedback Feedback aims to facilitate learning and help change behaviour, and is one of the most important skills required by supervisees and supervisors. Feedback aims to facilitate reflection


and knowledge of self by (1) describing current behaviour, (2) identifying progress towards a target behaviour, (3) identifying difficulties experienced, (4) providing guidance for future development. Feedback is:

Specific Factual Descriptive Constructive Clearly understood

Timed to be most useful Sensitive to the learner Directed at the behaviour, NOT he

person

When providing feedback, it is important to ensure feedback includes the following elements: Provides opportunity for the supervisee to evaluate their own behaviour/how they feel about

behaviour Describes what was observed (who, what, where, when, how) Explores alternative behaviours in order to improve, refine, correct.

Principles of the positive critique Vickey and Lake (2005) describe four key principles of providing positive critiques: Ask the supervisee what went well List the tasks you thought the supervisee did well Ask the supervisee what could be improved Add any other things you think could be improved

Tool Box Teaching on the Run Tip 10: Giving Feedback

http://www.meddent.uwa.edu.au/go/about-the-faculty/education-centre/teaching-on-the-run/teaching-resources

Appendix Three provides further tips on how to provide feedback. Appendix Four provides for tips on how to receive feedback. Appendix Five provides a framework for deciding the types of

feedback to provide. Appendix Six provides a tool to assess how well you provide

constructive feedback.

Activity: A Feedback Checklist Read the below scenario, and then using the feedback checklist, identify when Jenny is providing effective feedback or ineffective feedback. Jenny (Supervisor) has just observed Peter (Supervisee) undertake a clinical task. Jenny is now providing Peter with feedback on his performance.

Feedback Version One: Jenny: That was good Peter. You followed the procedure very accurately, and as per the guidelines. However, I have had reports from staff

Feedback Version Two: Jenny: That was good Peter. However, I have had reports from staff that you don’t usually do this procedure so well. This one might have been a fluke.




that you don’t usually do this procedure so well. What are your thoughts? Peter: I have been working with John on this procedure I feel that over the past week I have improved quite a lot. Jenny: Well done on taking the initiative to improve your skills. Would it be ok if I confirmed your performance with John?

Peter: No, I know that I have been getting better with this task. Jenny: Well, we will see – you sometimes think you are doing better than you are. Hang on a minute – let me ask John (calling John over to join the session).

Feedback Checklist

Effective Feedback Least Useful Feedback

Seek thoughts on their performance – self reflection

No opportunity for self evaluation

Focused – descriptive of observed behaviour

Personal – an attack on their personality

Positive

Negative – with no suggestions for change or opportunity to change situation

Specific Vague, non-specific

Useful – the person can change behaviour in given timeframe

Inaccurate - based on an incident that has since been corrected

Supportive Judgemental

Private Public

Factual – first hand evidence Second hand

Fair and honest Protective

Immediate Delayed

Regular Infrequent

Limit the quantity of feedback given in one session

Excessive

Dr Rick Ladyshewsky: Clinical supervision

2.5.2 Self Reflection Self-reflection is integral to the supervisory process. Supervision involves creating an ‘open communication’ environment, which encourages self-reflection by the supervisee and supervisor. Questions to Encourage Self Reflection

Nature of the Experience?

Describe the here and now experience. What essential factors contributed to this experience? What are the significant background factors to the experience? What are the key processes for reflection in this experience?

Reflection? What were you trying to achieve?


Why did you intervene as you did? What were the consequences of your actions for: - Yourself? The

patient / family? The people you work with? How did you feel about this experience when it was happening? How do you think the patient felt about it? What clues did you observe that lead you to think that was how

the patient was feeling? How did your actions match with your beliefs?

What factors created the result?

What internal factors influenced your decision-making? What external factors influenced your decision-making? What knowledge did or should have informed you? What sources of knowledge should have / did influence your

decision-making? What did you fail to consider

Alternative Actions?

How could you have dealt better with the situation? What other choices did you have? What might the consequences of these choices have been?

Learning? How do you now feel about this experience? How have you made sense of this experience in light of past

experiences and future practice? Has this changed your ways of knowing? How has this experience changed your ways of knowing? If unclear, what feedback, advice, or information might assist?

Model for Structured Reflection - Johns (1992) and Carper (1978)

2.5.3 Managing Conflict

Conflict is an unavoidable consequence of being in a relationship for a length of time, and is a normal part of relationships. Nevertheless it is important to deal with conflict in healthy ways. Toncich (1999) classifies conflicts between supervisors and supervisees into four categories:

• Interpersonal (issues with compatibility, arguments, communication, styles) • Belief system/alignment (judgements on approach to work, expectations) • Technical (disagreements over methods, approaches, skills) • Ethical/Moral (cultural differences, codes of conduct etc)

Further information about conflict resolution strategies can be accessed from the Conflict Resolution Network at www.crnhq.org/pages.php?pID=10

2.6 Clinical Teaching & Education In some supervisory relationships, clinical teaching is an important role undertaken by the supervisor. These will be further explored in subsequent supervision packages (e.g. supervision of students)

Tool Box Teaching on the Run Tip 4: Teaching With Patients



http://www.crnhq.org/pages.php?pID=10



2.7 Supervisee Stages It is important that supervision styles are tailored to the individual needs of the supervisee. These needs may depend on the supervisee’s requirements, knowledge, skills, development, expectations or the specifics of the situation. At the beginning of the supervisee relationship the supervisor and supervisee should reflect on the supervisee’s stage, and consider how this impacts on the supervision relationship.

SUPERVISEE STAGE

Evaluation/Feedback Transitional Self-Supervision Beginning

supervisee Supervisor has

dominant role Someone

unprepared or overwhelmed Focused on skills

acquisition.

Supervisee is growing in independence Supervisor views

supervisee as a participant Supervisee

participates in decision-making Autonomy is

increased Demonstrates

competence and knowledge Supervisee is learning

to analyze clinical sessions and her/his own behavior

Functions independently, and is responsible for actions and decisions. Supervisor views the

supervisee as an independent problem-solver Relationship becomes

more of a peer interaction Supervisee is beginning

to function independently but acts within the boundaries of expertise Supervisee can analyze

sessions and clinical behavior

2.8 Supervisory Style Supervisors must adjust their style dependent on the supervisee stage. It is important to also understand that the style of supervision will change according to the context/need of the supervisee e.g. if they are faced with a new, challenging or complex situation

SUPERVISORY STYLE

Directive Active Collaborative Consultative

Most appropriate for evaluation-feedback stage Supervisor is

directing Supervisee is

mainly passive

Moving away from evaluation-feedback and into transition or self supervision stages Dynamic, problem-

solving process Supervisor is less

direct, but not inactive Shared responsibility

and mutual input Jointly establish

objectives

Self-supervision is beginning Peer relationship

develops Supervisee is making

decisions Supervisee assumes

major responsibility for clinical outcomes and self-evaluation.


Activity: Style and Supervision Reflect on supervision relationships you are currently engaged in. As a supervisor what is the stage of your supervisee and what is your supervision style? As a supervisees what is your supervisor’s style and what is your stage as a supervisee?

2.9 Rights and Responsibilities All supervisory relationships should be grounded in an understanding of the rights and responsibilities of supervisee and supervisor.

SUPERVISEE As a supervisee you have the right to:

As a supervisee you have the responsibility to:

• Be treated with respect as an equal partner in the supervisory relationship

• Set the agenda • Confidentiality within agreed

limits, and to take action before confidentiality is broken

• Time to attend supervisory sessions • An uninterrupted space • Non-judgmental and supportive

response

• Use your time in an effective way • Prepare for sessions • Take actions decided in the session • Make an effort to create and

protect time • Be open to challenge • Identify practice issues with which

you need help with and to ask for time to deal with these.

• Be able to share these issues freely. • Contribute to reflective discussion. • Respond to feedback from his/her

supervisor in a structured and professional manner.

• Participate in the process of 'shared responsibility'.

SUPERVISOR As a supervisor you have the right to:

As a supervisor you have the responsibility to:

• Be treated with respect as an equal partner in the supervisory relationship

• Break confidentiality in agreed circumstances

• Challenge the supervisee’s practice, development or use of session as appropriate

• Refuse inappropriate requests from others about content of session

• Prepare for sessions • Be accessible, and protect time for

supervision. • Avoid letting sessions become

managerial or assessment focussed. • Maintain confidentiality • Admit to mistakes and weaknesses

and refer to other agencies or individuals where appropriate

• Challenge the supervisee’s development, practice or use of


• Set boundaries on areas you feel uncomfortable or unqualified to discuss

• Choice about who you supervise • Withdraw from a supervisory

relationship you feel is not productive or you cannot commit to (if appropriate)

session • Ensure your own personal support is

attended to, e.g. By finding your own supervisor

• Help explore and clarify thinking, feeling and beliefs, which underlie aspects of their professional work.

• Share experience, information and skills appropriately.

• Facilitate professional development and life long learning.

2.10 Empowered Supervisees Supervision is a two way process. Having skills in being a supervisee is just as important as being a competent supervisor. Supervisees should understand supervision enough to have a better sense of what they should be receiving, and accept responsibility for their role in getting the appropriate supervision.

Toolbox Appendix Seven provides some great tips for supervisees to ensure

that they are making the most out of their supervisory relationships.

2.11 Summary A good relationship between the supervisor and supervisee underpins effective supervision. When developing supervisory relationships, consider factors that have the potential to improve or undermine the relationships, communication, feedback, disclosure, self-reflection, trust and supervisory styles and stages.


3.0 SUPERVISORY PROCESS

Key Learning’s

Four common stages underpinning supervision. o Planning and Contracting o Assessment and Evaluation o Monitoring and Follow Up o Termination

During the planning and contracting stage consideration should be given to o Confidentiality (what will remain confidential and what won’t) o Frequency and timing (how often will you meet and for how long). o Supervision format (face to face, over the phone, in a group) o Timeframe and review (how long with the relationship last, when will you review) o Dispute and grievance (what happens when there is conflict) o Documentation (what documentation will be maintained) o Establishing goals and objectives (what will be the goals of the relationship)

Assessment and evaluation is a critical component of supervision – for both the supervisee

and supervisor. It may involve the supervisor undertaking direct observation and assessment of clinical skills, or it may involve utilising a range of indirect strategies that facilitate self-assessment and evaluation by the supervisee. The most important thing to remember is assessment and evaluation is two-way.

Clinical supervision is an ongoing process. Once goals have been established, monitoring

and follow-up are critical. Termination of the supervision relationship is typically undertaken with the agreement of

both parties. All supervisory relationships should be grounded in an understanding of the rights and responsibilities of supervisee and supervisor.

Supervision is a two way process. Having skills in being a supervisee is just as important

as being a competent supervisor


3.1 Introduction Section two highlighted the importance of developing a good supervisory relationship. Underpinning this relationship is a common sequence of events (or stages) that adds structure to supervision. Some supervisors and supervisees will welcome a well-defined structure to supervision including a step-by-step guide that indicates what to do and how to go about it. Others will require a much less structured approach. Nevertheless most supervisors and supervisees will benefit from a shared understanding of what is to take place, especially in the early stages of supervision.

3.2 Stages of supervision Models of supervision propose many different stages of supervision. However, most models have the following four common stages underpinning supervision. Planning and Contracting Assessment and Evaluation Monitoring and Follow Up Termination

3.3 Contracting & Planning The supervision contract is an agreement between the supervisor and supervisee about the supervisory goals, process and relationship. Contracts may be two-way (between the supervisee and the supervisor) or three-way (between the supervisee, supervisor and the organisation). Contracting needs to consider the following components: 3.3.1 Confidentiality It is essential that confidentiality regarding the content of the discussion, which takes place within supervision, should be maintained. It is necessary therefore that the limits to confidentiality are clearly defined. For example, confidentiality would not extend to areas where there is a significant concern such as safety (potential harm to self or another), breach of codes of conduct/ethics, and legislation. 3.3.2 Frequency and Timing The frequency and timing of supervision may require consultation with supervisee’s line manager. Both parties are responsible for arranging a mutually suitable time and venue and must take responsibility for advising the other with adequate notice of cancellations. 3.3.3 Supervision Format Supervision can take place in differing formats, for example one-to-one, peer group, group supervision or co-supervision. The supervision format is often determined by the context in which the supervision is occurring and the needs of the supervisee. Individuals may wish to try different formats at different stages of their careers; and different supervisory styles can be linked to different formats, for example supportive supervision in a peer group setting. 3.3.4 Timeframe and Review


It is good practice to conduct regular reviews of supervisory arrangements. Review should include consideration of the developing supervisory relationship, as well as the focus, content, and process of supervision. A reasonable practice is to initially plan to meet for a limited number of sessions (e.g. 3- 5) and review the progress of the supervision at an agreed time. Should the supervisor and supervisee then agree to continue, a new timeframe can be agreed and a framework for review established based on agreed goals for the supervision. 3.3.5 Disputes / Grievances. The supervisees should have access to a designated person to whom they can take concerns about the supervision process, preferably after an attempt to resolve such concerns with the supervisor. 3.3.6 Documentation Keeping clinical supervision records is essential as they provide a clear reminder issues or topics for discussion in future sessions, assist with evaluation and recognition of trends and protects the supervisee and supervisor in cases of legal or disciplinary action There are many ways to record supervision sessions. Minimum standards for recording include: Keep copies of all supervisory contracts and any updates; Record date and duration of each session; Keep a supervision logbook and enter notes on the content of each session, decisions

reached, agreed actions; Record in writing all regular reviews of supervision.

3.3.7 Establishing Goals and Objectives Goal setting is a critical aspect of supervision. It defines the content of the supervisory relationship. Good goals are SMARTER goals.

S Goals must be Specific and the more specific the better. State your goal as precisely as possible.

M Targets should be Measurable. That which you measure will be treasured, so think about how you will measure the achievement of your goal.

A Goals should have Accountability. Who or what are you accountable to for the goal?

R Goals must be Realistic. Unrealistic goals will lead to discouragement.

T Targets should be time based. Decide your time table for completion, and stick to it.

E Goals should be Exciting. Exciting goals will be met far sooner than boring, bland goals.

R Goals should be Recorded, in a place where you can look at it every day.

Toolbox See Appendix Five for the Five Principles of Goal Setting


Some Further Considerations for Goal Setting Specific challenging goals lead to better performance than vague ones Feedback on goal attainment enhances the process Goals should be prioritized if more than one Goal accomplishment and performance should be rewarded Goal setting is an important part of performance management Individuals need to develop action plans Organizational policies should be congruent with goal accomplishment Climate must be supportive

Activity: Supervision Template Review the supervision template in Appendix Nine. Using previous experience or past/current supervision relationships complete the template to generate a ‘mock’ supervision plan. What else is needed to be included in the template to make it work for you?

3.4 Assessment & Evaluation Assessment and evaluation is a critical component of supervision – for both the supervisee and supervisor. It may involve the supervisor undertaking direct observation and assessment of clinical skills, or it may involve utilising a range of indirect strategies that facilitate self-assessment and evaluation by the supervisee. The most important thing to remember is assessment and evaluation is two-way.

Activity: Assessment and Evaluation Reflection What are your experiences with assessment and evaluation, as a supervisor and a supervisee? Many supervisees view assessment and evaluation negatively? What can you as a supervisor do to change this view?

There are many ways in which assessment can be conducted in the clinical context:

Types of Assessment Comments

Direct observation

Not always the most reliable since you can't get at underlying theoretical knowledge and clinical reasoning skills. Good for observation of performance.

Indirect Observation

Recording a session, which can then be reviewed.

Review of written documentation

Written patient management problems are an objective means of evaluation with opportunities to evaluate the ability to extract and organize clinical information.


Written patient management problems

Various forms of information can be presented while evaluating the decision-making processes and ability to use information appropriately. The ability to understand and prioritise information is more controlled in a written situation.

Skills Rehearsal/Role Playing

Difficult inter-professional, interpersonal and patient care scenarios can be simulated using role-play. Attitudes and performance can be evaluated using this technique.

Discussion of Ethical Dilemmas

Evaluation of the attitudes and values can be measured by posing difficult ethical dilemmas to the learner. Examining their actions and decisions gives you insight into their decision making process.

Self-reports Can be used to find out what has been done. This gives you information about their time management, organisation and planning skills. They may also tell you what they did with patients and you can use this to determine their overall competence in managing and treating patient problems.

Special written projects or presentations

Case studies focus on clinical reasoning and knowledge integration.

Discussion of the clinical decision making process

Discussion about what was considered when making various decisions will reveal the rationale for these choices. Incorrect impressions can be rectified.

Supervisee's self-critique

Have supervisees prepare self-evaluation. Comparing the supervisor critique to the supervisee critique will reveal agreement and/or discrepancies in perspective's and impressions.

Dr Richard Ladyshesky: Clinical Supervision Lake & Hamdorf (2005) provide some tips for assessing competence and performance in the clinical setting Think about assessable moments. Structure work so you can observe behaviour. Gather information from multiple sources. Observe often and ask others (colleagues, nurses,

patients). Ask the supervisee how they think they are going. Give timely and constructive feedback and supporting the supervisee when things don’t go

well. Get the supervisee to describe and demonstrate. This will allow you to determine their

weaknesses 3.4.1 Enhancing the Objectivity of the Assessment & Evaluation Being objective in self-assessment and assessment of others can be quite difficult. Here are some tips to help: The assessment and evaluation should: Reflect the feedback that has been provided throughout the placement. Be clear about assessment and evaluation procedures. Maintain a positive encouraging atmosphere when discussing the assessment/evaluation. Be a mutually shared process. The supervisee should have the opportunity to self-critique

and give feedback. Focus on clinical performance rather than personality.


Reflect strengths and areas where improvement is required - it should be balanced so the supervisee learns what they do well and what requires further improvement.

Modifiable based on aspects of the learner's performance. Be based on enough evidence to ensure validity and reliability.

Dr Richard Ladyshesky: Clinical Supervision

3.5 Monitoring and Follow-up Clinical supervision is an ongoing process. Once goals have been established, monitoring and follow-up are critical. The primary vehicle for ongoing supervision and communication is the establishment of regular supervision sessions. Within this forum questions are raised, problems are managed and feedback is given based on discussion and observation. It is also a forum in which best practice is modelled by the supervisor. Future supervisory activities are also planned, which commence a new cycle in the stages of clinical supervision. This stage may involve the implementation of agreed actions, goal setting, the reinforcing of standards and planning in relation to future supervisory interventions.

3.6 Termination Termination of the supervision relationships is typically undertaken with the agreement of both parties. Some reasons for ending the supervision relationship include: The contracted period for the supervision relationship has concluded. One of you is moving away. One of you is starting a new job, which does not accommodate the supervisory relationship. Despite having worked hard, one or both of you are not satisfied with the supervision

relationship. The supervisee’s supervision requirements have changed, and the current supervisor is not

longer best placed to meet these requirements. It is important that termination is considered and planned for at the onset and during the supervision relationship.

3.7 Summary Whilst the supervisory process needs to remain flexible, the stages of supervision provide supervisors and supervisees with a shared understanding of the common steps in supervision. This is critical, especially in the early stages of the relationship and can ensure the maximum gain from the relationship.


4.0 EVALUATING SUPERVISION

Key Learning’s It is good practice to evaluate supervision at the end of sessions, at periodic intervals and

at the conclusion of the supervision relationship Evaluation can be of oneself, of the other person, or a combination (the relationship).

Evaluations questions can be directed at: Individual sessions The supervisory process The skills of the supervisor and supervisee The supervisory relationship The outcomes/gains from supervision.

A range of tools are available to assist in the evaluation of supervision.


4.1 Introduction Supervisees and supervisors should have the opportunity to discuss and learn from the clinical supervision relationship and process. It is good practice to evaluate supervision at the end of sessions, at periodic intervals and at the conclusion of the supervision relationship. The frequency of evaluation is largely dependent on the frequency of supervision meetings. Research suggests, interestingly, that most managers consider they supervise effectively and are inclusive while their employees think differently and rate their manager’s communication quality and quantity lower (Bell, 1996 cited in Willemyns 2003). In the supervision context, such findings highlight the importance of supervisor and supervisees reflecting on the supervisory relationship and identifying constrains and enablers. This section aims to provide an overview of the types of evaluation that can be undertaken. Tools for evaluation are often specific to the supervisory context, and will be provided in future packages.

4.2 Types of Evaluation Evaluation can be completed in a number of ways, including:

1. Evaluation of oneself (e.g. review checklists, critically reflect on qualities you have or have not demonstrated within the supervision relationship)

2. Evaluation of others (eg. the supervisor or the supervisee) 3. A combination of these (eg. the supervisor and supervisee individually and / or

collectively evaluating the supervision experiences, including their behaviour within the relationship, the ease and effectiveness of various forms, the processes used)

4.3 Evaluation Questions The below table outlines a range of questions which could be considered when evaluating supervision.

Session

How effective has the session been? What might have helped make it more effective? What might need further looking at? What has not been reflected on? What is still not clear? What actions could improve the quality of the supervision

relationship

Process

Has a supervision contract been established? Is it being frequently reviewed? Is documentation being maintained? Are the sessions frequent enough? Are we being accountable to the supervision arrangement?


Skills

Is the supervisor o Available (open, non-threatening, receptive,

trusting) o Accessible (easy to approach and speak freely with) o Able (have knowledge and skills to transmit) o Affable (friendly, pleasant, re-assuring)

Is the supervisee o Available (open, receptive, trusting) o Accessible (listens, engages) o Able (puts in to practice learning) o Affable (friendly, pleasant, re-assuring)

Relationship

Is the relationship a two-way process? What relationship challenges are there? Is the supervisor/supervisee communicating effectively with

each other? What external factors have impacted on the supervision

relationship?

Outcom

e

Does it ‘grow’ the supervisee and supervisor? Does it encourage and ensure compliance with organisational

and professional standards, policies and procedures? Does it result in improved consumer outcomes? Does it provide both support and challenge to the supervisee? Does it create a positive workplace?

4.4 Evaluation Tools A range of supervision evaluation tools are available. Many are specific to the type of supervision being undertaken (e.g. student supervision, peer supervision etc).

Toolbox Appendix Ten provides a self-assessment checklist to evaluate a

supervision session Appendix Eleven provides a short questionnaire to reflect on

supervisor skills required for good supervision.

4.5 Troubleshooting

Toolbox Appendix Twelve provides a trouble-shooting guide for a range of

challenges that may be encountered during supervision.

4.5 Summary Ongoing evaluation is critical to ensure the development of the supervisory relationship. Evaluation, both informal and formal, should be considered within the initial supervision contract, and undertaken periodically throughout the supervisor relationship.


5.0 Summary

Children’s Workforce Development Council (2007)

5.1 Key message for supervisors Being a supervisor is a significant responsibility and one that needs to be taken seriously. Yourorganisation and the individuals you supervise expect you to provide supervision that is: Based on a written agreement or contract Planned well in advance and only changed in exceptional circumstances Well-structured, allowing both you and the supervisee to contribute to the agenda Based on adult learning principles and learning styles Provided in an appropriate setting and free of interruptions Properly and promptly recorded, with notes copied to the supervisee.

5.2 Key message for individuals receiving supervision Supervision is an important right and benefit for all those working in a clinical setting. It is themain way in which an organisation or university monitors and reviews your work but also ensuresyou are properly supported and continue to develop your skills. It is therefore important that youare fully involved and make the most of the opportunities that supervision offers. In particular youshould: Prepare for each supervision meeting by reviewing notes from the previous meeting and

thinking about the things you want to raise for discussion Be ready to share your thoughts and ideas in the meeting Be open about what has gone well and what you have found difficult Be ready to plan and undertake training and other development activities as agreed with your

supervisor Check and read the notes of your meetings and make sure you follow through and complete

any actions as agreed. All supervisory relationships should be grounded in an understanding of the rights and

responsibilities of supervisee and supervisor. Supervision is a two way process. Having skills in being a supervisee is just as important as

being a competent supervisor

5.3 Further Learning and Development

This learning package has provided an introduction to the concepts of supervision. Take the time to reflect on the content of this learning package to plan further learning and development needs and opportunities in the area of supervision.


Supervision Development Plan

Situations in which I supervise

or am a supervisee

My strengths as a

supervisor/supervisee:

Areas where I need

improvement:

Areas I am interested in

learning more:

My individual objective for

the next 6 months:

My plan to achieve this

objective:


6.0 References & Further Reading Alsop, A. & Ryan, S. (1996). Making the Most of Fieldwork Education: A practical approach. Great Britain: Athenaeum Press. Ask, A., & Roche, A.M. (2005). Clinical Supervision: A Practical Guide for the Alcohol and Other Drugs Field. Adelaide: National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia. Downloaded from http://www.nceta.flinders.edu.au/pdf/clinical-supervision/TheGuide.pdf Caper, B. (1978). Fundamental Patterns of Knowing in Nursing, Advances in Nursing Science 1 (1) pp 13-23. Carroll, M. & Gilbert, M. (2005). On becoming a supervisee: Creating learning partnerships. London: Vukani Publishing. Children’s Workforce Development Council (2007). Providing Effective Supervision. Downloaded from http://www.cwdcouncil.org.uk/providing-effective-supervision Conrad, L. & Phillips, E. (1995). From Isolation to Collaboration: A Positive Change for Postgraduate Women? Higher Education, 30:313-122 Delano, F & Goldstein, J. (1992). If I Could Supervise My Supervisor. Workshop presentation, National Resource Center for Youth Services Conference, San Diego, CA. Emery, M. (1984) Effectiveness of the clinical instructor: Students’ perspective. Physical Therapy, 64, 1079 – 1083. Johns, C. (1992). The Burford Nursing Development Unit Holistic Model of Nursing Practice, Journal of Advanced Nursing, 16 (10) pp 1090-1098. Herkt, J. A. & Hocking, C. (2007). Supervision in New Zealand: Professional growth or maintaining competence? New Zealand Journal of Occupational Therapy, 54(2), 24-30 Honey, P and Mumford, A (1989). Learning Styles Questionnaire: Leaders' Guide. Organization Design and Development, Inc. Downloaded from http://www.plexusinstitute.com/edgeware/archive/think/main_diff3.html Kleffner, John H (2004). Becoming an Effective Preceptor. University of Houston College of Pharmacy. Downloaded from http://www.utexas.edu/pharmacy/general/experiential/practitioner/becoming.pdf Ladyshewsky, Richard K. Clinical supervision. Curtin University of Technology. Morrow, K (1984). Preceptorship in Nursing Staff Development. Rockville: Aspen Systems Corporation. Queensland University of Technology (2002). Supervision Solutions. Downloaded from https://olt.qut.edu.au/udf/supervisorsolutions/gen/index.cfm?fa=displayPage&rNum=494112. Roche, A.M. & Skinner, N. (2005). An Introduction to Workforce Development. In N. Skinner, A.M. Roche, J. O’Connor, Y. Pollard, & C. Todd (Eds.), Workforce Development TIPS (Theory Into


http://www.nceta.flinders.edu.au/pdf/clinical-supervision/TheGuide.pdf

http://www.plexusinstitute.com/edgeware/archive/think/main_diff3.html

http://www.utexas.edu/pharmacy/general/experiential/practitioner/becoming.pdf

https://olt.qut.edu.au/udf/supervisorsolutions/gen/index.cfm?fa=displayPage&rNum=494112

Practice Strategies): A Resource Kit for the Alcohol and Other Drugs Field. National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide, Australia. Downloaded from http://www.nceta.flinders.edu.au/wdt/. Shannon, S.J., Walker-Jefferies, M., Cayetano, T., Brown, K., & Petkov, J. (2006). Rural clinician opinion on being a preceptor. The International Electronic Journal of Rural and Remote Health Research, Education, Practice and Policy, 6, 410 (Online) Shaw, Peter (2006). Therapy Assistant Supervision. WA Country Health Service & Combined University Centre for Rural Health. Skills for Care (2007). Providing effective supervision. Downloaded from http://www.cwdcouncil.org.uk/providing-effective-supervision. Toncich, D D (1999). Key factors in postgraduate research: A guide for students, Chrystobel Engineering, Brighton, Vic. Willemyns, M., Gallois, C & Callan, V. (2003). Trust me, I’m your boss: trust and power in supervisor-supervisee communication. International Journal of Human Resource Management, 14: 117-127 Westberg, J., Jason, H. (1993). Collaborative Clinical Education: The Foundation of Effective Health Care, New York: Springer Publishing


http://www.nceta.flinders.edu.au/wdt/

http://www.cwdcouncil.org.uk/providing-effective-supervision

Appendix One: Strategies to promote Adult Based Learning in a Clinical Context

Concept Strategy

The learner must feel that there is something to learn and understands the need to learn

Goals should be meaningful and apply to personal and professional experience.

The learner should agree with the goals of the learning experience.

Learners should have some involvement regarding what will be learned. Open communication is critical to this process. Expectations must also be clearly laid out in order to prevent role confusion.

The learner is involved in planning & evaluating the learning experience

Review and reflect on the past experiences and performance. Having learners self-evaluate their own performance also emphasises the point that their views are important.

There is active participation in the learning process.

Most adult learners learn best by doing! Being involved facilitates learning as most adult learners acquire mastery through application, imitation, demonstration, participation experimentation and discussion.

Provide a safe learning environment Maintain a supportive learning environment that is free from threats and instead fosters self-esteem, freedom of expression and acceptance of differences where acknowledging mistakes as a necessary part of learning.

The information or skills that are being learned are practical and can be applied immediately.

Adult learners want to master immediate problems. These problems will change daily and the instructor can assist the learner in pinpointing areas in greatest need of resolution. Adults also use memory less and instead rely on creating relationships between old and new knowledge

Practice and feedback are critical components for adult learning.

Give the supervisee some responsibility and opportunities for practice. Provide timely and constructive feedback on performance.

Mutual respect and collegiality are important facets of a productive and rewarding learning relationship.

Respect for individuality is critical. Be sensitive when and where you give feedback, don't work against the supervisee when they are interacting with patients and other staff. Put yourself in his/her place. It is also important to legitimize emotional responses.

Issues of concern must be addressed. Negotiate plans, altered courses of action. Plan learning experiences together and if necessary, establish learning contracts or performance objectives.

Start with concrete problems and work towards the theoretical perspectives.

Get the learner to provide you with an assessment of the problem. Don't focus your energies on trivial bits theoretical knowledge.

Help the learners to establish patterns of recognition so that clinical pictures can be established. Don't focus on isolated sets of symptoms.

Ask probing questions to find out how the learner comes to certain conclusions. Tap into their thought process and methods of clinical reasoning. When demonstrating, explain what you are doing and why in order to assist learners in understanding pattern recognition.

The instructor must help the learner to differentiate between important and unimportant information.

Propose "what if" questions to learners that suggest complications or problems. Help them to discuss reasons why certain information may be useful at only certain times.

The instructor must direct the structure of the learning experience. Enough scope is required for the learner to draw inferences so that information and skill can be applied to future situations.

Process experiences with the learner. Explore why situations turned out in a particular way. Suggest alternative approaches and have the learner discuss different ways of dealing with the situation.

Dr Richard Ladyshewsky: Clinical Supervision


Appendix Two: Learning Styles

Learning Style Learn Best Learn Least Key Questions

ACTIVISTS Activists involve themselves fully and without bias in new experiences. They enjoy the here and now. They are open-minded, not sceptical, and this tends to make them enthusiastic about anything new. Their philosophy is: "I'll try anything once." They tend to thrive on the challenge of new experiences but are bored with implementation and longer-term considerations.

Engaged in new experiences, problems, and opportunities from which to learn.

Engrossed in short, here-and-now activities like a role-play or game.

Seeing excitement, drama, and challenge; things change; there are many activities.

Getting some limelight and visibility (they chair the meeting, give a presentation).

Thrown into the deep end with a task that they think is difficult.

Involved with others, bouncing ideas around and problem solving in teams.

Involved in a passive role like reading, watching, or listening to lectures.

Asked to stand back and not get involved.

Required to assimilate, analyse, and interpret lots of "messy" data.

Asked to engage in solitary work. Offered statements they see as

too theoretical. Asked to repeat essentially the

same activity over and over. Asked to do a thorough job, dot

all i's and cross all t's.

Will I learn about something really new to me?

Will there be a wide variety of activities or will I have to just sit a listen?

Will it be OK to get involved, let my hair down, make mistakes?

Will I encounter some tough problems and challenges?

Will there be other like-minded people with whom to mix?

REFLECTORS Reflectors like to stand back to ponder experiences and observe them from different perspectives. They collect data, both first hand and from others, and prefer to think about it thoroughly, postponing definitive conclusions as long as possible. Their philosophy is to be cautious. They are thoughtful people. They enjoy observing other people in action. They listen to others and get the drift of the discussion before making their own points.

Allowed and encouraged to watch, think, chew over activities.

Able to stand back from events and observe a group at work or watch a video.

Allowed time to think before acting; assimilate before commenting.

Carrying out painstaking research and investigation.

Provided an environment where they can exchange views with others without danger.

Can reach a decision on their own without pressure and tight deadlines.

Forced into the limelight (to chair the meeting, role play in front of others).

Involved in activities that require action without planning.

Given cut and dried instructions on how things should be done.

Worried by time pressures or rushed from one activity to another.

Will I be given adequate time to consider, assimilate, and prepare?

Will there be opportunities for me to assemble information for myself?

Will there be opportunity to listen to many points of view so I can decide for myself?

Will I be under pressure to decide on something too quickly or to extemporize?

THEORISTS Theorists adapt and integrate observations into complex, but logically sound theories. They think problems through in a vertical, logical, step-by-step way. They tend to be perfectionists who will not rest until things are tidy and fit into a rational scheme. They like to analyse and synthesize. Questions they frequently ask are: "Does it make sense?" "How does this fit with that?" "What are the basic assumptions here?" They tend to be detached, analytical, and dedicated to rational objectivity, rather than anything subjective or ambiguous.

Offered part of a system, model, concept or theory and challenged to find the rest.

Given time to explore methodically the associations among ideas and concepts.

Given time to question and probe (a Q&A session, or looking for inconsistencies).

Intellectually stretched. Listening to or reading about ideas that

are presented in a rational, elegant way. Offered interesting ideas and concepts;

immediate relevance is less important.

Pushed into doing something without context or apparent purpose.

Asked to participate in activities that emphasize emotion or feelings.

Given a hodgepodge of techniques with shallow explanations as in an overview course.

Doubtful that the subject matter is methodologically sound.

Out-of-tune with other participants (with Activists or people of low intellectual calibre).

Will there be plenty of opportunity to question?

Do the objectives of the activity indicate a clear structure and purpose?

Will I encounter complex ideas that will stretch me intellectually?

Is the subject matter "respectable;" sound and valid?

Will I be with people of similar intellectual calibre as myself?

PRGAMATISTS Pragmatists are interested in trying out ideas, theories, and techniques to see if they work in practice. They like to get on with things and act quickly and confidently on ideas that attract them. They are essentially practical, down-to-earth people who like making practical decisions and solving problems. Their philosophy is: "There is always a better way, and if it works, it is good."

Seeing obvious links between subject matter and problems on the job.

Shown techniques with obvious practical advantages (helps them get something done).

Given the chance to try something out with feedback from a credible expert.

Exposed to a role model they can emulate (through a case study, video, peer, etc.)

Given immediate opportunities to implement what they have learned.

Directed to concentrate on practical matters (such as drawing up a list of next steps).

Involved in learning that they do not see as immediately relevant.

Interacting with people they feel are distant from reality; "ivory-tower" people.

Not given opportunity to practice, nor clear guidelines on how to proceed.

Faced with political, managerial, or personal obstacles that prevent action.

Will there be plenty of opportunity to practice and experiment?

Will there be lots of practical tips and techniques?

Will we be addressing real problems and making real action plans?

Will I be exposed to experts who know how to do it themselves?

Adapted from Honey & Mumford (1989)


Appendix Three: Tips for Giving Feedback Tips for Giving Feedback • Be specific and constructive • Avoid giving meaningless praise • Focus feedback on the impact of behaviours on the client/session outcomes • Avoid emotional language • Give a balance of positive and negative • Be specific using examples • Use data collection to support your observations • Suggest possible alternatives or options for improvement • Pose questions that will facilitate learning • Be sensitive about when & where you give feedback to the supervisee • Put yourself in the supervisee’s/supervisor’s place • Keep feedback limited to the essential/important issues, as excessive feedback will not be

processed.

Giving Feedback CORBS model C - clear O - owned R – regular B - balanced S - specific

Appendix Four: Tips for Receiving Feedback Tips for Receiving Feedback Welcome Constructive Feedback Your powers of self-perception only go so far. People around you notice things, both good and bad, which you don’t and you might learn from their input. If you're not being offered enough feedback, ask for it! Listen Listen attentively. Keep an open mind, ask yourself: “How can I get the most out of this feedback?”. Ask questions to ensure you understand what's being said. ("So am I right in hearing you say that I need to manage my time better?") Do Accept Feedback At Face Value Although the feedback might feel like a personal insult, challenging your whole identity, keep some perspective. The feedback relates to specific instances, in one part of your life AND now you know about it, you have the opportunity to do something about it. Don't Ruminate On Feedback Avoid the temptation to re-enact the conversation to a friend as this only makes you feel ten times worse. Do talk about it with someone else, but make sure you’re emotionally detached first. Feedback is a Two Way Street Tell your supervisor what they do to support you and what they could do differently to enable better supervision. Ask your supervisor for help with roadblocks "in the system" that keep you from peak performance. Remember to Celebrate Strengths We all have areas we can improve on as well as things we are doing really well. Don’t just focus on the developmental areas. Celebrate and leverage your positive strengths. Make Your Choice How To Use The Feedback

Receiving Feedback Feedback can be a gift allowing you to grow and develop as a person, in a job or in a relationship. Ask yourself these questions:

LAAT model L – listen all the way through

• Is the feedback about a behaviour I can do something about? A – accept feedback without beingdefensive or explaining or limiting positivefeedback

• What will happen if I act on the feedback? What will happen if I do not act on the feedback?

• What actions will I take? A – ask for feedback you are not given andwould like to hear T – thank you

Foundat ions to Superv i s ion Page 39 WA Country Hea l th Serv ice September 2008

Appendix Five: Deciding the Type of Feedback to Provide: An Intervention Framework

Level of

intervention Type of intervention Purpose

Basic attending (BAS) 1 – Low

Basic listening (BLS)

Hear the supervisees information eg concerns, client issues, therapy delivery

Being supportive Hearing information and providing support acknowledging and self-disclosing.

Informative Providing information, advice and explanation.

2 - Moderate

Receiving feedback Receiving feedback by listening, asking and accepting.

Giving feedback Giving the supervisee clear, owned, regular, balanced and specific information.

Prescriptive Giving a direction to be followed.

Logical consequences Indicate the likely results of an action.

Assertive Asking to be treated with respect clearly and positively.

3 - High

Confrontative Be challenging and give direct feedback about incongruities in actions and words

Shaw (2005)


Appendix Six: Providing Constructive Feedback To what extend do I

Alw

ays

Frequently

Occasionally

Never

Establish and maintain a climate of trust in which supervisees welcome and invite feedback?

Arrange the proper setting for providing feedback?

Begin by inviting the supervisee’s self-assessment?

Ensure that supervisee identifies both what they did well as well as areas needing further work?

Ensure that my feedback is timely?

Link my feedback to each supervisee’s goals?

Link my feedback to my actual observation of supervisee?

Check out any hypotheses I generate about the supervisee’s performance?

Present feedback in nonjudgmental language, being as specific as possible?

Present the supervisee with objective evidence whenever possible?

Focus on the supervisee’s behavior and performance, not judgments about them as people?

Label my feedback as subjective, when it is?

Avoid overloading the supervisee with feedback?

Recognize that supervisee’s have varying levels of receptivity to feedback?

Convey support when providing feedback?

Avoid premature feedback?

Help the supervisee turn negative feedback into constructive challenges?

Encourage the supervisee to invite feedback; to let me know when it is difficult to hear my feedback

Provide follow-up to my feedback, whenever appropriate?

Westberg & Jason (1993)


Appendix Seven: Be an Empowered Supervisee Ask! Ask! Ask! The most direct and efficient way to get information is to ask

questions. Supervisee’s must be willing to ask the questions, and develop the skill to do so in a positive way, for the information they need. The crucial piece to all this is building the relationship necessary for "asking" to be comfortable.

View supervision as a way to grow personally and professionally and not as a threat

The supervisee needs to be willing to "risk" to grow. The mind set has to be that supervision is good and a tool for development and growth, not merely a monitoring device

Remember to ask the two “magic questions”

There will be times when a supervisee is frustrated by a decision the supervisor may make. The supervisee should ask himself or herself: • "What information do they have that I don't that will help me to

understand this better?" • "What information do I have that they don't that will help them

see it my way?" Learn and be willing to practice the art of constructive confrontation with your supervisor

Confrontation is often uncomfortable. However, if done respectfully and constructively it can add crucial depth to a relationship. Rather than sit angrily with an issue, try to find a way to constructively confront your supervisor about it. Keep in mind that constructive confrontation entails dealing with behavior and its effects and not "attitude." Remember that a successful confrontation should get the desired change but also preserve the self-esteem of everyone involved.

Bring an agenda to supervision

Direct the flow of your own supervision. One way to help structure the consistency of individual supervision is to bring an agenda each time. Give your agenda to your supervisor at least one day in advance so there are no surprises. You are establishing yourself as a thoughtful professional invested in learning and building trust with your supervisor.

"Insist" on an evaluation, and use your option to respond

All organisations have structured times for evaluations to be done. Learn when your time is due and respectfully remind your supervisor you are looking forward to engaging in this process.

Be empathic with your supervisor's issues and pressures

Supervisors are people too! They are frequently juggling multiple demands that may place stress on the supervisory relationship.

Remember: It's a relationship!

Like any other relationship in life it is not perfect, nor is it an "answer" to your problems and needs. Be honest, consistent, and dependable, and work hard to build trust. You will have to work together to make it successful – and be patient and understanding during the process

Delano & Goldstein (1992)


Appendix Eight: Five Principles of Goal Setting Clarity Clear goals are measurable, unambiguous, and behavioural. When a goal is clear and specific, with a definite time set for completion, there is less misunderstanding about what behaviours will be rewarded. You know what’s expected, and you can use the specific result as a source of motivation. When a goal is vague – or when it’s expressed as a general instruction, like “Take initiative” – it has limited motivational value. Challenge One of the most important characteristics of goals is the level of challenge. People are often motivated by achievement, and they’ll judge a goal based on the significance of the anticipated accomplishment. When you know that what you do will be well received, there’s a natural motivation to do a good job. When setting goals, make each goal a challenge. If an assignment is easy and not viewed as very important – and if you or your employee doesn’t expect the accomplishment to be significant – then the effort may not be impressive. Commitment Goals must be understood and agreed upon if they are to be effective. Employees are more likely to “buy into” a goal if they feel they were part of creating that goal. This doesn’t mean that every goal has to be negotiated with and approved by employees. As long as the employee believes the goal is consistent with the goals of the organisation, and believes the person assigning the goal is credible, then the commitment should be there. Feedback In addition to selecting the right type of goal, an effective goal program must also include feedback. Feedback provides opportunities to clarify expectations, adjust goal difficulty, and gain recognition. With all your goal setting efforts, make sure that you build in time for providing formal feedback. Task Complexity People who work in complicated and demanding roles probably have a high level of motivation already. However, they can often push themselves too hard if measures aren’t built into the goal expectations to account for the complexity of the task. It’s therefore important to do the following: Give the person sufficient time to meet the goal or improve performance. Provide enough time for the person to practice or learn what is expected and required for

success.


Appendix Nine: Supervision Contract

Supervisee

Supervisor

Agreed Content of Supervision

Goals, objectives etc

Agreed Expectations

Supervisor Supervisee

Agreed Duration, Frequency and Timing

Duration of Relationship From: To:

Review Date

Method Face to face, videoconference, telephone etc.

Format Individual, peer, group

Frequency

Duration

Out of Session Contact

Total Time Available per Month

Documentation Who and what is to be recorded, what records are to be kept and by whom?

Confidentiality

We agree to keep all discussion in clinical supervision confidential. There is a legal duty of care that may override confidentiality in exceptional circumstance (e.g. unsafe, unethical or illegal practice).

Evaluation How will we evaluate is the relationship is successful?

Supervisor Supervisee

Date Date

Signature Signature


Appendix Ten: Evaluating a Supervision Session Use the below questions to reflect on an individual supervision session. Complete the questionnaire immediately after the session.

YES NO Was the opening informative and relaxed?

YES NO Was the session structured appropriately and the main points to be covered summarized?

YES NO Did you seek clarification or check understanding from the supervisee/supervisor?

YES NO Did you raise or ask if there were any other issues to discuss?

YES NO Was the time set aside for the session used effectively?

YES NO Did you treat the supervisee/supervisor as an individual, valuing their particular skills and contributions and not a stereotype?

YES NO Were exchanges frank and open or guarded?

YES NO Was there too much readiness on the supervisee/supervisors part to agree or disagree with you?

YES NO Did you use appropriate questioning techniques (open questions)?

YES NO Did you interrupt or talk too much and ignore any leads or suggestions?

YES NO Did you eject other viewpoints too easily?

YES NO Did you check your understanding of comments?

YES NO Has the session improved your relationship with your supervisee/supervisor?

YES NO Did you discuss obstacles that may hinder progress?

YES NO Did you minimize or completely avoid difficult issues and realities?

YES NO Did you react emotionally at any point?

YES NO Did you/the supervisor use your authority or ‘put down’ the supervisee to try to settle disagreements or conflict instead of negotiating, reasoning and listening?

YES NO Will progress be encouraged as a result of the discussion?

YES NO Was anything not fully resolved – do you need to get back together?

YES NO Did the physical arrangements provide for open and relaxed discussion (eg seating, privacy, comfort, freedom from interruptions)?

YES NO Did you both leave the meeting with a clear understanding about what is expected by your next session?

YES NO Is there a written record of the outcomes of the session?

YES NO Did you set a time for your next session?

YES NO What action do you need to take to improve the process for next time? Queensland University of Technology, Supervisor Solutions


Appendix Eleven: Qualities of an Effective Supervisor This tool can be used by supervisors to self-assess and reflect on their supervision skills, or by supervisees to reflect on their supervisor skills.

Supervisor Skills

Always

Most of the

Time

Some of the

Time

Never

Communication • Is an active listener • Encourages dialogue and questions • Communicates in a non-threatening manner • Openly and honestly discusses perceptions and issues • Open to conflicting ideas and opinions Interpersonal Relationship • Creates a comfortable learning environment • Provides appropriate support for concerns, frustrations and anxieties • Demonstrates positive regard for the supervisee as a person • Is accessible (provides time for supervision) Professional Skills • Possesses and demonstrates broad knowledge • Displays competence • Sensitivity to client needs • Demonstrates professional behaviour • Provides a systematic approach to problem solving • Explains the basis actions (assessment, management etc) • Serves as a role model • Demonstrates practical applications of knowledge and skills • Manages time well and demonstrates leadership Supervision (Teaching, Instruction, Evaluation) • Allows progressive and appropriate independence • Assists the supervisee in defining objectives for supervision • Assesses progress systematically • Provides frequent and constructive feedback • Uses evaluation as a constructive process • Questions and coaching to facilitate learning • Identifies discrepancies in performance • Accurate in documenting supervisee’s performance • Provides supervisee opportunities to practice technical & • Observes performance discreetly

Emery (1984)


Appendix Twelve: Trouble Shooting Personality Conflicts Strategy

Supervisor and supervise have difference expectations.

Poor communication and unclear or differing expectations will inevitably lead to conflict. Sometimes, the intervention of a third party is required to enable resolution of this conflict.

Supervisor and supervise have different values

Values are very personal and involve subjective feelings. There are no clear-cut rights or wrongs. Problems of conflicting values may occur if both parties refuse to compromise and recognise the others right to their own value system.

Supervisee is fearful Fear may stem from a misinterpretation of what is expected or the belief that one should or must know everything.

Supervisee is unable to organise or get work done on time

Patience is the key word! Organisation and prioritisation skills come with experience. Less experienced supervisee’s often under or over estimate how long it takes to accomplish one or more tasks. The supervisor will be able to help by saying, “this should take you about half an hour because you’re new at it. Later, it will only take about ten or fifteen minutes.” Role modelling is an important learning process. Seeing how an experienced staff member prioritises and organises time will assist students in their own development. Sharing some of your experiences, and acknowledging there are days when all they can do is “to keep their head above water”, helps them realise that this occurs periodically.

Supervisee has difficulty setting priorities

Sensitivity and patience are the keywords! This and the previous problem often go together. Supervisees will initially have difficulty in recognising what is important, what should come first and why. They need help in defining what needs action, what does not, what is acceptable and what is not.

Non-Communication Supervisee feels threatened by the supervisor

Unclear expectations most commonly precipitate this problem. The supervisee is not perfect, and must be allowed to make mistakes. This is part of the learning process. Sometimes, supervisors have too high an expectation of both themselves and the student. This needs to be discussed, or the burden of so covert an expectation, will further exacerbate the feeling of threat.

Supervisee feels fearful or insecure

Initially, insecurity is normal. If prolonged, this will inhibit learning, growth and development. The supervisor needs to be aware that genuine praise helps overcome this feeling.

Supervisee is unaware of his/her limitations

Firstly, the supervisor needs to determine if the supervisee really does not know that help is needed. If they do not, then the problem is most likely from lack of insight. The problem must be promptly and openly addressed, or will lead to a feeling of resentment for the supervisor and confusion for the supervisee.

Supervisor is too busy Insufficient time to spend with supervisees may be the result of work overload. New supervisors may need help in time management to provide quality time for supervision.


Unclear directions or one-way communication

Ask open-ended questions to determine their level of experience. This promotes two-way communication.

Feedback Supervisee’s habits are inappropriate

Explore ways to utilise your sensitivity and tact before confronting the supervisee. You would be wise not to approach the issue from a personal standpoint.

Dual Responsibility Supervisor carrying a heavy client load

The supervisor needs to acknowledge that be supervising requires an adjustment in their usual work patterns. This is especially important for time limited supervision (e.g. students).

Morrow (1984)


WA Country Health Service

www.wacountry.health.wa.gov.au

or

Angela Durey

Combined Universities Centre for Rural Health

www.cucrh.uwa.edu.au

For enquiries regarding this package please contact:

Suzanne Spitz

http://www.wacountry.health.wa.gov.au/

http://www.cucrh.uwa.edu.au/

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