Research Paper: Supervision of Clinical Work in Mental Health

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Social Work

Supervision of Clinical Work in Mental Health

Mental health nurses along with other practitioners, often work in an ever changing and challenging environment. Because of this there is a continuing need for support. It is often thought that this support helps to increase morale, decrease strain and burnout, and encourage self-awareness and self-expression. Clinical supervision often addresses all these issues and improves the quality of care for patients (Rice, Cullen, McKenna, Kelly, Keeney and Richey, 2007).

Clinical Supervision is a competency-based approach that is often used to train and supervise mental health practitioners. For a long time supervision has been central to training psychologists and other mental health professionals who work in clinical settings. There was a time when there was little or no framework or guidance for those in this field (Falender and Shafranske, 2004). Clinical supervision in nursing has been described as a global phenomenon, however, it is a notion that lacks clear definition both in terms of its conceptualization and Operationalization. Despite the inconsistency in conceptualization, many experts have acknowledge that there are common threads that run through most definitions, in that it involves the provision of empathetic support to improve clinical skills and knowledge and foster a culture of reflective practice. Furthermore, this process takes place within a supportive environment in which the individuals are able to develop their own clinical practice and lend support to others (Cross, Moore and Ockerby, 2010).

Clinical supervision is a framework and a process whereby a clinical practitioner (supervisee) has the opportunity to meet regularly with an experienced colleague (supervisor) and discuss issues of relevance to their practice. It has been stated that patients and their families must be the beneficiaries of clinical supervision as it is after all a system to support and develop the professionals offering care to them. The principal factors relating to the need for clinical supervision in mental health nursing are:

1. The shift to community-based care for mentally ill people

2. increasing numbers of patients with complex illness and multiple diagnoses being admitted for assessment and treatment

3. introduction of clinical governance, placing the responsibility for the quality of care jointly on organizations and on individuals within organizations

4. increased emphasis on effectively managing risk the need to maintain registration through self-regulation activities (Rice, Cullen, McKenna, Kelly, Keeney and Richey, 2007).

It has been identified that there have been issues surrounding the definition of clinical supervision. Clinical supervision in mental health nursing: is a supervisee-led formal process where protected time is facilitated for professional support and learning; enables practitioners to develop knowledge, competence and skills required to provide best care; is ongoing bringing practitioners (supervisees) and skilled knowledgeable supervisors together in a supportive, environment; facilitates ongoing reflective practice and is a commitment throughout their professional career; is aimed at advancing clinical autonomy and self-esteem leading to personal and professional development. There are also countless clinical supervision models and many are relevant to mental health nursing practice. There is general acceptance that the models of clinical supervision should recognize the needs of specific groups. Some experts have suggested that clinical supervision is often underused because of misinterpretation, problems with organizational endorsement and supervisory relationships, and lack of funding or time (Rice, Cullen, McKenna, Kelly, Keeney and Richey, 2007).

In organizations where clinical supervision is measured, it is often found that staff scored lower on burnout and stress scores than in the control group of other organizations. It has not been possible to demonstrate that clinical supervision made any difference to patient outcomes. Clinical supervision is an inoculation against stress. It has been found that efficacious clinical supervision can make a contribution to supervisee well-being. The culture of the organization was crucial to the success of clinical supervision, and that effective supervisors are be rendered ineffective if they are not supported by their managers (Clinical supervision 'can inoculate staff against stress', 2010).

Supervision is necessary to counselor development both personally and professionally.

Supervision is triadic in nature, involving a supervisor, a supervisee, and a client. Within this relationship, the supervisor aims to foster and enhance the supervisee's professional development and competence as well as to ensure the client's welfare through the monitoring of the quality of professional services (Sangganjanavanich and Black, 2009).

Researchers have suggested that the supervisory relationship and working alliance between supervisees and supervisors is significant. A functional relationship is essential for certain knowledge to be conveyed from supervisors to supervisees. In the best of times, this relationship is intended to promote growth in supervisees and can be a source of trust, support, and understanding. In the worst of times, it can be a source of confusion, conflict, and misunderstanding. Conflict in supervision happens when the supervisor and supervisee are not able to communicate their needs and concerns to one another. Cross-cultural issues in supervision may occur when the supervisor, supervisee, and client differ in terms of ethnicity, language, age, gender, sexual orientation, socioeconomic status, spirituality belief, or willingness. Many studies have reported that multiculturalism or diversity in supervision is a potential issue influencing supervisory relationships (Sangganjanavanich and Black, 2009).

The counseling profession has recognized the importance of multicultural issues in training, however, there are few empirical studies focusing on this issue. In studies done in regards to multicultural supervision it has been found that supervisees and supervisors spent almost 15% of their supervision time addressing multicultural issues. Some participants have reported that it would have been beneficial for them if more time had been focused on multicultural issues in supervision. Miscommunications, misunderstandings, hidden agendas, assumptions, and disconnections between supervisors and supervisees seemed to occur when supervisors fail to initiate, explore, or discuss cultural issues in supervision (Sangganjanavanich and Black, 2009).

The power differential in supervisory relationships had the potential to impact the environment in which supervisees could address multicultural issues. Supervisees believed they were unable to voice their concerns. As a result, experiences and perspectives of supervisees regarding multicultural supervision were often unspoken and unheard. Supervisors who failed to integrate culture as a part of the supervision process were likely to experience frustration and resistance from their supervisees, and eventually the supervisees silenced themselves in supervision (Sangganjanavanich and Black, 2009).

Clinical supervision, within cooperative and supportive organizational cultures, has a creative potential to address difficult issues concerning non-aggressive yet assertive professional practice promoting good relationships with oneself and others. Subsequently, encouraging assertive yet reciprocal approaches to developing healthy working alliances in health-care settings seem possible. Even so, clinical supervision is in itself a complex undertaking, sometimes leading health-care professionals to contest with themselves and with the often harsh realities of the professional world in which they live and work. Potential exists to revisit emotionally troubling events arousing feelings of vulnerability, hurt, anger, guilt, shame, and in some situations, dependence on the supervisor. There is a need therefore for clinical supervisors to be alert to the dynamics of human service and to the potential for deleterious effects on health-care professionals. Supervised clinical practice has long held a centrality to psychological therapies and has evolved as an integral component of such services, offering support to practitioners and providing some measure of quality control. Nursing has sometimes struggled with coming to terms with supervised clinical practice, perhaps because in some instances, the term has been associated with failing and professional frailty Yet the notion that health-care professionals are recurrently strong and perpetually able to give of themselves while never needing support in return is an anachronism. In face of the demands of contemporary professional nursing practice, such ways of thinking make up powerful conventions. Nonetheless, because of feelings of insufficiency referred to earlier, they are unlikely to be successfully challenged without periods of personal conflict. However, if work discussions, which take place in clinical supervision, are supported and encouraged by organizations and are sensitively planned in ways that allows the restoration of emotional balance in health-care professionals, then the process learning elements of clinical supervision can provide experiences, which mobilize realistic hope for constructive professional practice. Fears might be reduced along with the better management of uncertainties aroused through providing health care (Jones, 2008).

It is the function of leadership to guide individuals and groups towards the goals and strategy of the organization and to assist, lead and support staff to achieve an optimal outcome from both an organization and employee perspective. As a result, leadership skills and the leader's well-being at work emerge as critical success factors. It is necessary for the leaders of an organization to attend to their own development on a continual basis. The leader's personal development requires evaluation of leadership activities and not just outcomes, operations and staff. The development of the leader's personal skills is a fundamental part of the development of the organization. The leader's personal qualities influence the way they lead people. It is usually not possible to examine and develop these qualities in knowledge-oriented management training. Other means of development are needed, such as administrative clinical supervision, where leaders can examine their leadership styles and… [END OF PREVIEW]

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