This paper reports on selected findings from a novel randomised controlled trial (RCT) conducted in mental health settings in Queensland, Australia. Several national and state reports recently revealed the sub-optimal state of Australian mental health service provision which have direct implications for mental health nursing, including the privately experienced cost of working and coping in these settings. Clinical supervision (CS), a structured staff support arrangement, has shown promise as a positive contribution to the clinical practice development agenda and is now found reflected in health policy themes elsewhere in the world. However, CS is underdeveloped in Australia and the empirical evidence base for the informed implementation of CS, per se, has remained elusive. Within the overall context of a RCT design, therefore, and supplemented by other data collection methods, this large and generously funded study attempted to make an incremental contribution to better understanding this demanding subst...

A randomised controlled trial of clinical supervision: selected findings from a novel Australian attempt to establish the evidence base for causal relationships with quality of care and patient outcomes, as an informed contribution to mental health nursing practice development

Background
Schwartz Center Rounds® (Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.

Objectives
How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.

Design
(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).

Setting
(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).

Participants
(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.

Results
(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.

Limitations
Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.

Conclusion
Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

Clinical supervision: The way forward? A review of the literature.

In the present study, we outline the evolution of a process-focused reflective practice group (RPG) model for nurses working in clinical settings. The groups were initiated at Redcliffe and Caboolture hospitals by the consultation liaison psychiatry nurse and author. An associated article provides an evaluation of these RPG. The literature review identifies the key themes and theories on which the model is based, and the article outlines the process and practicalities of facilitating RPG in critical care, midwifery, and oncology specialties over a 3-year period. The model proposes that the effectiveness and sustainability of RPG arises from adequate preparation and engagement with prospective participants. Group rules, based on principles of confidentially, supportiveness, and diversity, were collaboratively developed for each group. Facilitation utilized a group-as-a-whole approach to manage process and stimulate reflection. While the purpose of RPG was a reflection on interpersonal aspects of nursing, contextual workplace issues were frequently raised in groups. Acknowledgement and containment of such issues were necessary to maintain clinical focus. The literature highlights facilitator credibility and style as crucial factors in the overall success of RPG, and it is proposed that reflective practice as a process-focused model for groups succeeds when nurse facilitators are trained in group process and receive concurrent supervision.

Reflective practice groups for nurses: a consultation liaison psychiatry nursing initiative: part 1--The model.

https://www.collegianjournal.com/article/S1322-7696(12)00015-7/pdf

Exploring resilience in paediatric oncology nursing staff.

The role of the NHS in supporting qualified nurses is important for the development and retention of staff. Although there is a general perception that clinical supervision is beneficial and leads to better outcomes of patient care, most literature focuses on the main functions of the supervisory role, the interactions between supervisee and supervisor, or the supervisory process. There is limited large-scale empirical evidence on nurses’ receipt of clinical supervision or their perceived need of its various dimensions. This paper reports findings from a large-scale nationally representative sample of diplomate nurses who qualified between 1997 and 1998. Using Proctor’s model, it discusses the experiences of clinical supervision of 1,918 nurses in early career, 18 months after qualification, from the adult, child, learning disability and mental health branches. The findings show that the receipt of clinical supervision varied among the branches. Just over half of learning disability and mental health dipl...

The policy-practice divide: who has clinical supervision in nursing

Commitment to PREP

This paper discusses the benefits of using SPlus software to carry out longitudinal analyses such as event history methods. An illustration is provided using three-year career histories of a nationally drawn cohort of recently qualified registered nurses, who completed a diploma programme in the UK between August 1997 and September 1998. For the purposes of this paper, the time to first promotion is examined using a Cox proportional hazards model with a frailty term included, to allow for unobserved heterogeneity. The results indicated that men have a slightly higher rate of promotion compared with women, and particularly when compared with women who took a maternity break during their early career. Age is also a significant factor, with younger cohort members being promoted at a higher rate than their older colleagues. The inclusion of a frailty term to account for clustering at the university level also significantly improved the model. It is shown that SPlus, which is a powerful, user-friendly statistical package, can be easily utilized by researchers to carry out event history analysis as well produce high quality cumulative hazard and diagnostic plots using its sophisticated graphics facilities.

The use of SPlus software to analyse event history data: An application to the early career promotion of nurses in UK

Commitment to PREP: What do recently qualified learning disability nurses think about keeping themselves professionally updated? Carol Desousa and Sarah Robinson report on some early findings from a major study

Carol Desousa

Papers

The policy-practice divide: who has clinical supervision in nursing

Commitment to PREP

The use of SPlus software to analyse event history data: An application to the early career promotion of nurses in UK

Commitment to PREP: What do recently qualified learning disability nurses think about keeping themselves professionally updated? Carol Desousa and Sarah Robinson report on some early findings from a major study