Perspectives about and models for supervision in the health professions
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Perspectives about and Models for Supervision in the Health Professions. Violet H. Barkauskas, PhD, RN, MPH, FAAN The University of Michigan . Focus of the Presentation. The context of health care Frameworks for supervision in health care Examples of framework application

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Perspectives about and models for supervision in the health professions

Perspectives about and Models for Supervision in the Health Professions

Violet H. Barkauskas,PhD, RN, MPH, FAAN

The University of Michigan


Focus of the presentation
Focus of the Presentation Professions

  • The context of health care

  • Frameworks for supervision in health care

  • Examples of framework application

  • Evidence of effectiveness


Context of health care western
Context of Health Care - Western Professions

  • Hierarchical system of oversight

  • Clinical supervision is a major emphasis because of:

    • Concern for patients

    • Current re-emphases on patient safety

    • Reimbursement & certification regulations

    • Concerns about litigation


Common examples
Common Examples Professions

  • Training & education – students in all professional discipline

  • Professional development requirements

  • Oversight of assistant/ancillary personnel

    • Common (almost ubiquitous) in most settings, especially for nursing

    • Examples – nursing assistants in hospitals & nursing homes, home health aides, community health workers


Proctor s model of supervision 1987
Proctor’s Model of Supervision Professions(1987)

  • Normative – Administration & Quality Assurance

    • Manage projects

    • Ensure patient safety

    • Assess & assure quality

    • Improve practice

  • Restorative – Support & Assistance with Coping

    • Identify solutions to problems in practice

    • Alleviate stress

  • Formative – Education & Professional Development

    • Skills & knowledge


Applications of the model
Applications of the Model Professions

  • Normative (management, safety, assurance)

    • Meetings

    • Observation of care

    • Formal evaluation

    • Telephone consultation

    • Documentation in hard & electronic media

      • Patient records

      • Activity logs

  • Restorative (support & assistance with coping)

    • Group supervision

    • Case conferences

    • Identification of solutions to problems in practice

  • Formative (education & professional development)

    • Continuing education


Heron s model of supervision 1989
Heron’s Model of Supervision Professions(1989)

  • AuthoritativeSupervision Interventions

    • Prescriptive – direct behavior

    • Informative – give information/instruct

    • Confronting – challenge

  • FacilitativeSupervision Interventions

    • Cathartic – release tension/strong emotion

    • Catalytic – encourage self-exploration

    • Supportive – validate/confirm


Powell s model of supervision 1993
Powell’s Model of Supervision Professions(1993)

  • Components

    • Administrative

    • Evaluative

    • Clinical

    • Supportive

  • Conceptualization of supervisor as a servant leader who

    • Is self-aware

    • Operates with focus & energy

    • Is proficient in many aspects of the job

    • Makes the organizations mission & vision clear by standing ahead of the followers while standing behind their actions

    • Shares power

    • Values people by caring for them


Assumptions of powell s model of clinical supervision powell 1993
Assumptions of Powell’s Model of Clinical Supervision Professions(Powell, 1993)

  • People have the ability to bring about change in their lives with the assistance of a guide.

  • People do not always know what is best for them as they may be blinded by their resistance to & denial of the issues.

  • The key to growth is to blend insight & behavioral change in the right amounts at the appropriate time.

  • Change is constant & inevitable.

  • In supervision, as in therapy, the guide concentrates on what is changeable.

  • It is not necessary to know about the cause or function of a manifest problem to resolve it.

  • There are many correct ways to view the world.


Structure of supervision
Structure of Supervision Professions

  • Individual – 1 to 1

    • 1 supervisor & 1 supervisee

  • Group

    • 1 supervisor with 4-6 supervisees

    • Triad – 1 supervisor & 2 supervisees

    • Team – colleagues working together outside the group

    • Network – people not usually working together outside the group

  • Administrative Arrangements

    • Hierarchical

    • Non-hierarchical


Supervision venues
Supervision Venues Professions

  • Routine interactions on the job

  • Informally

  • In scheduled meetings

  • Indirectly – e.g., by talking to patients

  • Through remote communication

    • Telephone

    • Computer

    • Written documentation, e.g., logs, records, reports


Current supervision debates
Current Supervision Debates Professions

  • Qualifications of the supervisors

    • From the same discipline

    • A different discipline

    • A peer colleague

    • Expertise

      • Content of care

      • Processes of development

  • Guided reflection vs. more traditional clinical supervision

  • Collaborative supervision

    • May not challenge each other sufficiently (Walsh et al., 2003)


Evidence supervision effectiveness kilminster jolly 2000 p 833
Evidence - Supervision Effectiveness Professions(Kilminster & Jolly, 2000, p. 833)

  • Supervision has a positive effect on patient outcome & lack of supervision is harmful to patients.

  • Supervision has more effect when the trainee is less experienced.

  • Self-supervision is not effective.

  • The quality of the relationship between supervisor & supervisee is probably the single most important factor for effective supervision.

  • Behavioral changes can occur quickly – changes in thinking & attitude take longer.


Tips Professions

  • Combine supervision with focused feedback

  • Continuity

  • Reflection by both participants


Characteristics of effective supervisors
Characteristics of Effective Supervisors Professions

  • Empathetic

  • Supportive

  • Flexible

  • Interested in supervision

  • Track supervisees effectively

  • Link theory with practice

  • Engage in joint problem-solving

  • Interpretative

  • Respectful

  • Focused

  • Practical

  • Knowledgeable


Characteristics of ineffective supervisors
Characteristics of Ineffective Supervisors Professions

  • Rigid

  • Low empathy

  • Low support

  • Failure to consistently track supervisee concerns

  • Failure to teach or instruct

  • Indirect & intolerant

  • Closed

  • Lack respect for differences

  • Non-collegial

  • Lacking in praise & encouragement

  • Sexist

  • Emphasize evaluation, weaknesses, & deficiencies


Recommended content for supervisor training
Recommended Content for Supervisor Training Professions

  • Supervision frameworks

  • Assessment of learning needs

  • Teaching the adult learner

  • Counseling

  • Provision of feedback

  • Issues of power & social stratification

  • Transcultural relationships


References

Heron, J. (1989). ProfessionsSix category intervention analysis. Guildford: Human Potential Resource Group, University of Surrey.

Kilminster, S. M., & Jolly, B.C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34, 827-840.

Powell, D. (1993). Clinical supervision in alcohol and drug abuse counseling. San Francisco: Jossey-Bass .

Proctor, B. (1987). Supervision: A cooperative exercise in accountability. In M. Marken, & M. Payne (Eds.). Enabling and ensuring supervision in practice. Leicester: Youth Bureau and Council for Education and Training in Youth and Community Work.

Sloan, G., & Watson, H. (2002). Clinical supervision models for nursing: Structure, research and limitations. Nursing Standard, 17(4), 41-46.

Walsh, K. et al. (2003). Development of a group model of clinical supervision to meet the needs of a community mental health nursing team. International Journal of Nursing Practice, 9, 33-39.

References


Questions

QUESTIONS? Professions


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