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

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

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 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?

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

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)

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

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 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

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.