Clinical Supervision Is a Phenomenon

Clinical supervision is a phenomenon that is applicable in several of both the caring and medical professions. It serves as a monitoring device to promote both integrity and excellence in the profession of its focus. In the nursing profession, for example, clinical supervision is not only a device to control the actions of inexperienced nurses. It also provides recently qualified nurses with a safeguard in times of uncertainty, and with the opportunity for learning about the professional within a practical setting. There are various theories, concepts and practical applications of clinical supervision. Central to an adequate understanding of the benefits of supervision is the fact that theory must relate to practice and vice versa in order to optimize this device within any profession in which it is used.

According to Duncan McLean (1996), for example, clinical supervision is indeed a device for teaching factual information, but it also transcends this function. Whereas it is indeed usual to teach the application of theory within the clinical setting, it is also useful in providing the basis for practical application. McLean appears to imply that theory and practice go hand in the clinical situation. The author however also goes a step further in indicating that clinical supervision itself should form the basis of scientific study.

The content and method of clinical supervision can be investigated in order to apply these concepts best to practice. The differences and best application of inter- and intra-disciplinary supervision can for example be investigated. Within inter-disciplinary supervision, the nursing profession can be combined with other professions such as psychiatry and social work to obtain the optimal care of a nursing patient. A patient's needs may require the combined skills of a social worker and psychiatrist, one of which can be the clinical supervisor.

McLean also emphasizes the importance of judgments and decisions in addition to scientific principles when conducting clinical supervision. Scientific principles can for example form the basis of more arbitrary situations, where the supervisor needs to use his or her discretion in making effective decisions. Often, such decisions are based upon a variety of dynamic factors, including the professional relationship between client and caregiver, and the clinical situation the service provider and the client face. In this clinical supervision is beneficial, as the supervisor can provide various guidelines on decision-making procedures and considerations. McLean notes that every clinical situation is different, and often requires critical thinking in order to ensure best practice. Clinical supervision can play a vital role in this.

Lyth (2000, p. 722) notes that there have been various descriptions of the clinical supervision concept within the nursing profession. According to some, its main purpose is the development of professional skills. Others view its most important focus to be on the development of reactions to practical situations and concerns. Based on the specific concern within the specific institution and persons involved, clinical supervision is also implemented in different ways. Furthermore, Lyth also notes that this very uncertainty about the exact nature of supervision may result in resistance to its implementation.

In discussing the literature on the subject, Lyth (2000, p. 725) identifies several models of supervision. These, according to the author, can manifest as three types: those with a focus on the relationship between the supervisor and supervisee, those that focus on a role description, and those that describe the process of supervising. In the nursing profession, the author notes that the main concepts involve in the supervisory relationship include the normative, the formative, and the restorative functions.

The normative relates to organizational and quality control, where the role of the supervisor is mainly to monitor and encourage the quality of work, along with the adherence of this work to the standards within the company. The formative in turn focuses on education and development, where the nurse's knowledge and skill are enhanced, while the restorative focuses upon support. This function concerns the general well-being of the nurse, and the relationship of this wellness to the quality of work being done.

In further models, various role functions are combined in order to ensure the best possible application via problem solving techniques. In clinical situations, for example, problem-solving techniques are often required to ensure best practice. According to Lyth, some authors argue that a balance between roles should be maintained in order to optimize both clinical practice and theoretical knowledge.

Generally, it appears to be agreed among theorists that the focus of clinical supervision should be professional development and self-actualization. In addition, an inter-disciplinary approach to supervisory practice will also provide a platform for emerging best practice among the various professions, and ultimately benefit the practice in nursing. Although it appears that the theory on clinical supervision is often arbitrary and little researched, it is also true that the phenomenon has been in effect of many years, decades, and even centuries. For midwives, for example, supervision has been part of their profession since 1902, being a statutory requirement.

One problem with clinical supervision, according to Lyth (2000, p. 276), is the fact that it is often linked to a hierarchical process within the nursing profession, rather than with a practical and necessary application of teaching and learning. Indeed, this connects with a relatively negative perception of supervision among nursing professionals.

Ideally, supervision should be an integrated relationship among professionals, where the person with superior knowledge and experience makes him- or herself available for a reciprocal learning and teaching process. Indeed, Todd and O'Connor (2005, p. 4) note that the supervision process entails a collaboration between two or more practitioners, of which one is more experienced than the others in the group. In this relationship, the supervises is allowed to conduct practical work with clients, which is then assessed in a regular, systematic and detailed way. The main purpose of this type of supervision is to make suggestions regarding best practice for emerging professionals. As such, the main aims include to improve clinical practice, to enhance the ability of the supervisee to meet professioanl standards, the support of encouragement from the supervisor. In a high-stress environment such as nursing, this could have the ultimate effect of providing support in times of stress.