Across nursing and healthcare, the supervision of students is an important component of training and learning. Clinical placements and the experiential learning experience are essential for developing and applying learned theoretical knowledge in the clinical environment. Undergraduate, graduate, postgraduate and new staff are all some of the unique supervision opportunities for nurses to support. Not every nurse will be interested in formal education, but it is likely they will be a preceptor or supervisor. Therefore it is important nurses understand the skills required for effective supervision. Skills such as reflective practice, assessment and feedback are part of this supervision. Being made to feel welcome and recognised as an important part of the team, just basic socialisation aspects to the nursing team.
Supervision is defined “as a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, and is acknowledged to be a life-long process” (Martin, Copley, & Tyack, 2014, p. 201).
“Clinical Supervision is regular, protected time for facilitated, in-depth reflection on clinical practice” (Bond and Holland,1998 p. 12)
Models of Supervision
Proctor’s model of supervision is perhaps the most commonly used within health care. “Supervision towards reflective practice” (Proctor, 2010). Proctor’s framework focuses on 3 areas of supervision:
Clinical Supervision Skills Review Tool
This Clinical Supervision Skills Review Tool is a helpful resource to review your supervision skills. More about this resource in the video below.
Note: This blog post resources and notes were taken from attending an education session ran by Monash University on supervision.
Boud, D., & Molloy, E. (2013). Rethinking models of feedback for learning: the challenge of design. Assessment & Evaluation in Higher Education, 38(6), 698-712.
Carrucan-Wood, L. (2015). Preceptorship: Grounding and growing the next generation. Nursing Review.
Department of Health and Human Services. (2015) Clinical Supervision Skills Review Tool. Victorian Government, Melbourne.
Hattie, J., & Timperley, H. (2007). The power of feedback. Review of educational research, 77(1), 81-112.
Martin, P., Copley, J., & Tyack, Z. (2014). Twelve tips for effective clinical supervision based on a narrative literature review and expert opinion. Medical teacher, 36(3), 201-207.
Proctor, B. (2010). Training for the supervision alliance: Attitude, Skills and Intention. In Routledge handbook of clinical supervision (pp. 51-62). Routledge.
Sloan, G., & Watson, H. (2002). Clinical supervision models for nursing: structure, research and limitations. Nursing Standard (through 2013), 17(4), 41.
Winstanley, J. (2000). Manchester clinical supervision scale. Nursing Standard (through 2013), 14(19), 31.
Time is Muscle
Delivering continuous ST-segment monitoring for those at risk of myocardial infarction can provide a dynamic approach to cardiac monitoring, picking up changes in the ST-segment. This can supplement the continuous bedside ecg monitoring, static 12 lead ecg and monitoring the trend of cardiac enzymes such as Troponin’s, CK, CK-MB.
This is not new technology, its been around since the mid-1980s. Take a read of the resources below on the theory, how to set up, best lead for monitoring of suspected occluded coronary artery for monitoring of ischaemia.
ST and STEMI Maps
Keywords: ST Elevation; J-Point; Myocardial Infarction; AMI; STEMI; NSTEMI
Sangkachand, P., Sarosario, B., & Funk, M. (2011). Continuous ST-segment monitoring: nurses’ attitudes, practices, and quality of patient care. American Journal of Critical Care, 20(3), 226-238.
Sandau, K. E., & Smith, M. (2009). Continuous ST-segment monitoring: protocol for practice. Critical care nurse, 29(4), 39-49.
Leeper, B. (2003). Continuous ST-segment monitoring. AACN Advanced Critical Care, 14(2), 145-154.
Aust, M. P. (2011). continuous St-segment Monitoring. American Journal of Critical Care, 20(3), 239-239.
GE Healthcare. (2010). Quick Guide 12 Lead ST-segment Monitoring.
Sydney LHD. (2015). Continuous ST Monitoring in Intensive care Unit (ICU).
Note: This post is not sponsored or endorsed by an products or companies, it’s purely focused on understanding monitoring technology and potentially enhancing the level of care delivered in acute coronary care situations. Please share any other monitoring methods or technologies in the comment section below.
Journal Club Article: Reader, T. W., & Cuthbertson, B. H. (2011). Teamwork and team training in the ICU: Where do the similarities with aviation end?. Critical care, 15(6), 313.
Comparing the lessons learnt and development of team training approaches in the aviation industry to the complex needs of the Intensive Care Unit (ICU). The importance of teamwork and the coordination of behaviours in terms of patient care provided and subsequent outcomes. Higher levels of doctor-nurse collaboration improve safety and mortality rates. The recognised importance of poor communication which has been identified as a factor in medical error.
Team input and team processes = team output
“Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. ”
“team-related ‘active failures’ (for example, failures to communicate the proximity of nearby aircraft) and ‘latent failures’ (for example, lack of team training, poor ergonomic design, and organizational culture) that influence behavior and error in the cockpit.”
“Techniques include exposing teams to high-stress situations, training pilots to facilitate team discussions before and after stressful team activities, and cross-training aircrew team members to understand the demands and needs of one another’s role. Teams are trained in a multidisciplinary environment…….”
The ability to understand other roles, so in stressful events still work together as a team and negative behaviours and attitudes don’t effect performance.
“Fatigue and stress are known to negatively influence performance in the ICU, and non-technical factors such as team communication, situation awareness, and decision making frequently underlie error.”
Developing a workplace culture based upon safety requires supporting and valuing staff in the high risk environment of ICU, with models of training and supervision that focuses not only on the norms of practice (normative) and educative training, but on restorative and supportive resources to improve stress and burnout, and aid personal development.
Keywords: Intensive Care Unit; Team Performance; Human Factors; Team Training; Aviation Industry; Cognitive Load; Situation Awareness.
Relevant additional resources around some of the themes identified in this articles to aid collaborative educational teamwork:
Fun To Imagine
Feynman, R. P., Leighton, R. B., & Sands, M. (2011). Six easy pieces: Essentials of physics explained by its most brilliant teacher. Basic Books.
The Feynman Lectures on Physics. (2013). The Feynman Lectures on Physics. California Institute of Technology.
Gates, B. (2016). The Best Teacher I Never Had. www.gatesnotes.com
Microsoft. (2009). Project Tuva: Richard Feynman’s Messenger Lecture Series.
Wikipedia. (2018). Richard Feynman.
Follow an honorary Twitter account on Richard P Feynman
I am currently learning how to use SPSS for statistical analysis to enable some basic statistical analysis to be conducted in nursing research projects. The aim is to be able to run initial data analysis on small clinical focused projects and try to support other nursing colleagues in their project ideas (#community of practice). Understanding more about the data process and how to choose the correct statistical method is a complex process and an ongoing learning objective. Below are some introductory resources that may help you plan your project and provide helpful tips on how to save your data set, analyse the data, create demographic and result tables. Access to a statistician remains key, as they provide so much expertise and understanding around data analysis, and they provide a robustness to the results process. If you have useful research resources please post them in the comment section below and we can develop this post as an ongoing research resource for nurses. As I use SPSS on further projects, more resources will be added into this page.
The Research Question
Consider something that inspires, interests or annoys you- motivation is key, especially if the project is done in own time. Or a quality measure that will help change and enhance practice.
Conduct a literature review to explore the background scientific findings on your topic and then provide a rationale for your study. Why is it important to conduct? Set out your aims and objectives, also any hypothesis if required. When analysing the evidence base, use expert resources such as Joanna Briggs Institute critical appraisal tools.
Consider your topic and what data needs to collected to meet the aims and objectives. Will this be a quantitative or qualitative study?
Before your collect any data, check in with your hospital or university ethics committee to see what level of ethics your project sits under. Be prepared for some form filling and some unique wordology. If you delve further into the history of ethical standards, be prepared for some moving and challenging cases.
Prepare a data file, this will depend on the software you have access to. So far the easiest and cheapest way I have found is to use Xcel that can then normally be uploaded into a stats software package (accessed on a University computer) and you can use formula’s from this program to obtain most of the basic stats you will need for a first draft data analysis. Remember, have the variable along the x axis (across the top) and participant number along the y (down the side). Determine and define your variables, also create a code book to label any values. Borrow a book that can guide you through the research steps and the software program. This is the one I used: Pallant, J. (2013). SPSS survival manual. McGraw-Hill Education (UK). If you are a student, check with your university IT team to see what software you can access or download onto your personal computer.
Get inspired by Florence Nightingale, who was much more than just the lady and the lamp. You will need to describe the setting, participants and statistical methods. Again a book with statistical advice on how to choose, run and review your result findings will be required, such as Tabachnick & Fidell (2007) Using multivariate statistics. Ideally have a statistician to mentor you through the process.
Return to your literature review and see what types of figures and tables were published in the results sections and replicate this format so you can then compare your results to previous literature. Do the same with the demographic tables, helps determining if mean or median should be used (median more robust I hear you say).
Add these key results and link in with context of background discussion. What are the implications from your findings, and also any limitations of the study.
Thinking around the bigger picture of healthcare research and publications. Positive or negative data results, we only see a biased picture in that often only positive trials are published so they are what influence healthcare practice.
Pick a journal that fits in with your topic or methodology. Check in with the publisher author guides if you aim to publish, and they will provide clear outlines for structure, content and referencing style.
Joanna Briggs Institute. (2017). Critical appraisal tools.
Pallant, J. (2013). SPSS survival manual. McGraw-Hill Education (UK).
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Allyn & Bacon/Pearson Education.
Nursing is often voted the most trusting profession, is this due to the humanistic approach of traditional nursing or looking further back into the history of nursing and the vocational ‘Florence’ holistic caring approach? As nurses engage in technology to deliver care and encroach into areas of medicine to increase the nursing scope of practice, are we at risk of losing the therapeutic nurse-client relationship? If we reflect on the fundamentals of nurse training, it was likely based around nurse theory and systems of care, and surprisingly not the core standards that hospitals use as measurements of quality that nurses are faced with on a day to day basis no matter what the level of acuity or staffing. Theorists and models of care such as Benner, Henderson, Orem, Rogers, Roy and Roper, Logan & Tierney – and each country will likely have certain theories that form the backbone of its nurse training curriculum. Look at the concepts, and see we are still trying to encourage independence, return power to the patient, end pyjama paralysis, provide effective rehabilitation and ensure healthcare is evidence based and ideally available for all.
Keywords: Care, compassion, competence, communication, courage and commitment (The 6 C’s).
Below are some great online resources, don’t forget to revisit those text books gathering dust on your healthcare book shelf.
“Nurse retention is a global problem across all specialities but is exacerbated in critical care areas where elevated nurse–patient ratios and the use of advance technologies require greater numbers of highly educated and specialized nurses impacting costs and quality of patient care.”
Factors identified in previous research such as working conditions, burnout syndrome, organisational climate, staffing levels, empowerment, personal health and work pressure.
Relevance to practice:
“The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care.”
A systematic mixed-method literature review.
3 themes identified were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences.
Empowerment and professional development opportunities. Having enough time to recover from night shifts and the impact of inflexible rotations on work–life balance.
2. Nature of working relationships
When conflict occurs with families and relatives. Poor relationships between nurse to manager and nurse to physician, especially not being involved in the decision making process.
3. Traumatic/stressful workplace experiences
Futility in the level of care being provided, caring for the dying patient and decisions to forego life‐sustaining treatments.
High nursing turnover is a global issue and nurse leaders in critical care areas need to take these findings into consideration when developing strategies to improve turnover and support strategies.
Keywords: Burnout; Culture: Nurse Retention; Stress; Teamwork.
Additional Resource: Best Nursing Degree from Shanna Shafer (BSN) regarding shortage of nurses and also nurse faculty in the US, and reshaping the future of nursing and nurse education.
Do we interact and engage with our phones more than we do with our fellow humans? Interesting question, and this is where eye gazing comes in to remind us of the connection and interactions we make though our eyes. These are important questions as we spend our lives connected through work and play in an online world and in particular social media platforms. As the real world becomes entwined with virtual reality and robots, what will our lives look like in the future and how will humans connect? If technology increases in healthcare, what will the nurse-patient relationship look like?
Keywords: Trust, connection, healing, bonding, sacred, relaxing, spiritual.
Where Has Human Connection Gone?
Eye Gazing With Strangers
Kajimura, S., & Nomura, M. (2016). When we cannot speak: Eye contact disrupts resources available to cognitive control processes during verb generation. Cognition, 157, 352-357. [abstract]
Nursing Education Network. (2018). Meet The Avatars: Virtual Reality and Virtual Humans.
SBS. (2018). Look Me In The Eye.
Virtual Reality and Virtual Humans
This great video shows some of the complexities of technology, especially around virtual reality and how to combine with humans. The emotions when we get down to relationships from the humanistic aspect are amazing, a little lump in the throat. Have a watch, and take the time to think if you could interact with a friend or family who is no longer alive, firstly would you use VR to connect and how would you prepare for the feelings and experience? This great piece shows the difficulty in entwining technology around what makes us human. Not forgetting history is important too, and VR can help save memories from the people experiencing them like no history book every could. This is human endeavour pushing the boundaries.
“A people without the knowledge of their past history, origin and culture is like a tree without roots” quote by Marcus Garvey.
Meet The Avatars
Some additional resources from Meet The Avatars