Supervision Skills and Frameworks

Lecturer -Fiona Couper

Florence Nightingale School of Nursing & Midwifery

Clinical Supervision

• Proctor: functions of supervision

• Formative

• Normative

• Restorative

• Nicklin: practice-centred model

• Educational

• Managerial

• Supportive

Structures for supervision

• Individual or one-to-one • senior supervisor with a junior supervisee • peer supervision

– equal status (mutual supervision)– ‘round-robin’ set-up

• Group supervision• team• single professional group• mixed professional group

Bond and Holland Categories of Supervisor Skills

Directive

Non-directive

Challenging

Informative

Catalytic

Supportive

Skills of the Clinical Supervisor:

Informative Skills Giving factual information

there is a staff support group that meets every month Providing rationale for your action(s)

we need to move on now so that there is time for ….. Illuminating the process

I notice that we often avoid talking about …... Identification of a need

I wonder if you would find it helpful to …. Interpretation

it seems like …..

Skills of the Clinical Supervisor:

Challenging SkillsA challenging intervention aims to raise awareness It should be based on behaviour It requires sensitivity Raising the agenda

– I think we need to talk about ...Challenging statements

– you refer to her as ….. which sounds …..Challenging inconsistency

– you said … and yet ….Challenging questions

– What led you to react in that way?

Catalytic Skills Catalytic skills aide thinking, reflection

and problem-solvingOpen questions

– What happened?Listening skills

– You said you tried several times.Alternative perspectives

– How did the patient / client react?Expressing interest / enquiry

– In what way? What did you think about it?Problem-solving activitiesConsidering options

Supportive Skills• Validation

– It sounds like you managed the situation really well at the time

• Positive feedback– I like what you said about …..– I agree with you , it’s a good idea

• Empathy– From what you’ve told me it sounds like it was a

difficult decision and you still seem quite unsure about it

• Caring/ Respect– Punctuality, reliability– Giving time and attention

Page and Wosket Cyclical Model (2001)

Contract

Bridge

Review

Focus

Space

Page and WosketCyclical Model of Supervision

• Contract• boundaries, accountability• expectations, relationship

• Focus• issue, priorities, objectives

• Space• investigation, challenge, debate• new perspectives, reflection• collaborative problem solving

• Bridge• identify learning, consolidation • strategies, actions, goals

• Review• feedback, evaluation • re-contracting

Page and Wosket (2001)

• Cyclical model of supervision with five key stages

– Contract– Focus– Space– Bridge– Review

• The stages each have five steps

Contract

• ground rules

• boundaries

• accountability

• expectations

• Relationship

• An initial contract is typically written

• Contracting at each session typically focuses on timing and negotiation for presentations

Focus

• Issue

• Objectives

• Presentation

• Approach

• Priorities

• Key Questions– What do you want to bring to the session to work on?– What do you want to get from the session? What are

your expectations?

Space

• Collaboration• Investigation• Challenge• Containment• Affirmation

• Space to explore, consider options and alternative perspectives, reflect on strengths and limitations or think about alternative strategies

Bridge

• Consolidation

• Information giving

• Goal setting

• Action planning

• Clients perspective

• Preparing to take learning, insights or ideas from the session to practice

• Going from general to specific

Review– Feedback– Grounding– Evaluation– Assessment– Re-contracting

• Have you achieved what the supervisee wanted to achieve?

• Do you need to make any changes in the way you are working?

• Is there anything to take forward for the next session?

• Includes ongoing evaluation and periodic evaluation of outcomes

Stages of group development

• Forming• Issues of inclusion and belonging; safety

• Storming• Issues of power and influence• Difference, competence and hierarchy

• Norming• Shared group culture and values

• Performing• Effective working group

• Mourning• Tuckman, cited Proctor (2000)

Skills of the Supervisor

• Bond and Holland (1998)

Directive

Informative Challenging

Non-directive

Catalytic Supportive

Solution-Focused One-to-One Supervision

Five Stage Model (O’Connell 2005)

• Stage 1: Negotiate session goals• Stage 2: Working with the supervisees

strengths• Stage 3: Future thinking• Stage 4: Scaling progress• Stage 5: Ending

Solution Focused Skills

• Exception seeking• Giving credit to the supervisee• The miracle question• scaling

Mutual Respect

• There is an expectation that there will be mutual collaboration

• Both parties taking mutual responsibility for their roles

• Curiosity is an essential ingredient

• Supervisor is not the expert,rather an individual who validates the supervisee’s experience

Stage 1: Negotiate session goals

• The primary focus in supervision is on the practitioner in relation to the client, not on the client himself e.g. What do you hope to gain from the session today?

• Supervisor could ask about pre-session change e.g. In the time leading up to this session, have there been any changes in the situations we wanted to discuss today?

Stage 2: Working with the supervisee’s strengths and solutions

• The supervisor enquires about the supervisee’s competence and facilitates an exploration of how s/he could do more of what works

• e.g. Which skills does this client elicit from you?• e.g. What does your client find helpful?• e.g. How could you do more of it?

Stage 3: Future thinking• The supervisor may use the miracle question and

develop the answers by asking these type of questions:

• What else would you notice?• What skill or quality did the miracle bring you?• It is important to remember that the miracle

(change) happened to the practitioner, not the client.• If the practitioner changes the chances are the client

will as well.

Stage 4: Scaling Progress

• Scaling may happen at any stage of the process but may naturally flow from answers to the miracle question

• If 10 is that you are doing a good job with this client and 0 is the complete opposite, where do you think the client would put you?

• Where would you put yourself?

Stage 5: Ending• The supervisor will give the supervisee feedback

about s/he came over in the session itself and highlight what the supervisee is doing that is helpful for the client.

• I liked the way you handled…• The supervisor may hand the ending of the session

over to the supervisee• Could you sum up what you are taking away from the

session today? (You may want to point out positives that the supervisee has missed.)

References Bond M and Holland S (1998) Skills of Clinical Supervision for

Nurses. Buckingham: O.U. Press Brown A and Bourne I (1996) The Social Work Supervisor.

Buckingham: O.U.Press Driscoll. J (2000) Practicing Clinical Supervision. London:

Bailliere Tindall Nicklin P (1997) A practice-centred model of supervision.

Nursing Times. 93 (46) 52-54 Page S and Wosket V (2001) Supervising the Counsellor. A

cyclical model. 2nd edition. London: Routledge Power S (1999) Nursing supervision. A guide for clinical

practice. London: Sage van Oojen Els (2000) Clinical Supervision. A practical approach.

Edinburgh: Churchill Livingstone.