Week 11: Clinical Supervision and Managing Self-Care

Question 1

What are general ways nurses can self-care for themselves (protective practices)?

Answer 1

Help compartmentalise work from the rest of life
Clarify & support staff in establishing professional boundaries - trust staff to care for patient while you are away
Promote emotional & physical health
Promotes self-care techniques for managing stress

Question 2

What are self-care skills for when dealing with a difficult patient or situation?

Answer 2

Support clinicians dealing with difficult patients/family
Reduce conflict over goals of care: don’t make the situation more stressful
Reduce conflict within teams
Often use humour: helps to make sense of situations which would otherwise be difficult to manage
Don’t take it home

Question 3

What are organisational strategies for promoting self-care?

Answer 3

Have processes for actively managing distress & dysfunction in staff members
Create opportunities for debriefing
Focus on team work
Promote areas of autonomy & recognise achievements
Work culture which supports work/home balance: exercise classes, cheap gym membership, fun activities
Sets limits on expectations
Access to confidential supportive services

Question 4

What is Clinical Supervision?

Answer 4

Life long, ongoing process involving formal, respectful reflection of practice
Scrutinising your own practice and learning from your colleagues
Protected time off the ward, not rushed or spontaneous

Question 5

What are the types of Clinical Supervision?

Answer 5

Point of Care
Facilitated Professional Development
Reflective Practice

Question 6

What are examples of Point of Care CS?

Answer 6

Clinical Teaching
Clinical Facilitation
Preceptorship
Buddying

Question 7

What are examples of Facilitated Professional Development CS?

Answer 7

Peer review
Coaching
Mentoring

Question 8

What is the Reflective Model of CS?

Answer 8

Regular, planned sessions to reflect on work or professional issues
Formal/structured
Individual or group
Not with someone who directly manages you
Aims: improved practice and development, exploring new ways of handling difficult situations, more reflective, vibrant and professional staff

Question 9

Why is it important to promote spontaneity and creativity in nursing?

Answer 9

Spontaneity in interactions with patients
Each interaction is unique
Need to be spontaneous and creative with interactions to remain personal
Creativity: responding to each situation differently, treat each one uniquely
Burnout: not able to treat each situation uniquely, not identifying why a situation frustrates you

Question 10

What is the exclusion criteria for CS?

Answer 10

The supervision or oversight of clinical work by another staff member who is in a line management role
Individual performance review
A form of discipline procedure
Preceptorship or mentoring
Critical incident debriefing
Psychotherapy or counselling

TL;DR. It’s not:
Management: telling you what to do
Education: telling you how to do it
Counselling: helping you solve your personal problems

Question 11

What is discussed in CS?

Answer 11

A work issue the supervisee decides is important and has prepared for:
Issues arising from patient care
Issues arising from interactions with patients/families
Issues arising from interactions with other staff members: common in such an intimate and diverse work place
Traumatic experiences in providing care
Ethical/moral issues
Professional boundaries
Maintaining professional standards
Challenges in working in a large organisation

Question 12

Why should CS be done?

Answer 12

Assist you to reflect on clinical practice in order to provide best possible care for the patient
A space to think about an issue in a structured manner
Self care
Increased work satisfaction –> improved patient outcomes

Question 13

What are the benefits to the individual in participating in CS?

Answer 13

Increased feelings of support, job satisfaction and morale
Promotion of work based learning and the development of new skills
Increased professional discipline, growth and identity
Reduction in professional isolation, levels of stress, emotional exhaustion & burnout

Question 14

What are the organisational benefits in participating in CS?

Answer 14

Improved recruitment and retention of staff Beneficial risk management strategy for an organisation
Promotion of quality assurance and competent best practice

Question 15

How can we learn from reflection?

Answer 15

Reflection leads to understanding at different level and learning how to do things in and enhanced way.
It can prompt you to consider personal values and assumptions about patients and other staff
Forced to confront how someone else may have been feeling in a situation

Question 16

What are the stressors associated with end of life care?

Answer 16

Cumulative grief: multiple losses over a short period of time
The effect of cumulative grief on health care professionals is well established
All areas of healthcare: anywhere where loss occurs
Working with death and dying has an impact
You need to be aware of what your own triggers are: someone similar to your own age, reminds you of parents

Professional boundaries: its crucial to maintain boundaries order to be able to work in nursing. It’s easy to think of the really obvious boundaries we should never cross.
Would I do this for every patient?
Why am I feeling connected to this patient?
Am I over sharing?
Is my personal response influencing my care?
Can’t provide care without healthy boundaries: too detached or too attached

New stressors: social media
The care you provide is very important, but you don’t have a huge role in this person’s life

Question 17

How do you reflect on your role in an interaction between you and a colleague, supervisor or patient?

Answer 17

Behaviour: what were you doing and what was the other person doing?
Cognition: what were your thoughts and what do you believe the other person was thinking?
Affect: how were you feeling and how do you think the other person was feeling?

Question 18

How do you develop a self-care plan for yourself?

Answer 18

Identify warning signs of stress: physical, emotional/cognitive, relational, spiritual
Identify actions strategies to promote self care
Identify supports: who around you has a positive impact, who has a negative, who do you work well with, what patients, families and situations do you work well with