1. Supervision Skills and Frameworks
Florence Nightingale School of Nursing & Midwifery
Supervision Skills and Frameworks
Lecturer -Fiona Couper

2. Clinical Supervision Proctor: functions of supervision Formative
Normative
Restorative
Nicklin: practice-centred model
Educational
Managerial
Supportive

3. 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

4. Bond and Holland Categories of Supervisor Skills
Directive
Non-directive

5. 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 …..

6. Skills of the Clinical Supervisor: Challenging Skills
A 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?

7. Catalytic Skills
Catalytic skills aide thinking, reflection and problem-solving
Open 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 activities
Considering options

8. 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

9. Page and Wosket Cyclical Model (2001)

10. Page and Wosket Cyclical 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

11. Page and Wosket (2001)
Cyclical model of supervision with five key stages
Contract
Focus
Space
Bridge
Review
The stages each have five steps

12. 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

13. 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?

14. Space Collaboration Investigation Challenge Containment Affirmation
Space to explore, consider options and alternative perspectives, reflect on strengths and limitations or think about alternative strategies

15. 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

16. Review Have you achieved what the supervisee wanted to achieve?
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

17. 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)

18. Skills of the Supervisor
Bond and Holland (1998)
Directive
Informative Challenging
Non-directive
Catalytic Supportive

19. 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

20. Solution Focused Skills
Exception seeking
Giving credit to the supervisee
The miracle question
scaling

21. 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

22. 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?

23. 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?

24. 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.

25. 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?

26. 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.)

27. 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.