자연주의적 탐구조사(Naturalistic Inquiry)

Context
Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective.

Purpose
To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision.

Content
The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness.

Conclusions
The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2923.2000.00758.x

Effective supervision in clinical practice settings: a literature review

Currently considerable emphasis is placed on the promotion of person-centred care, which has become a watchword for good practice. This paper takes a constructively critical look at some of the assumptions underpinning person-centredness, and suggests that a relationship-centred approach to care might be more appropriate. A framework describing the potential dimensions of relationship-centred care is provided, and implications for further development are considered.

Beyond person-centred care: a new vision for gerontological nursing.

Context. In order to design interventions that increase research use in nursing, it is necessary to have an understanding of what influences research use.

Objective. To report findings on a systematic review of studies that examine individual characteristics of nurses and how they influence the utilization of research.

Search strategy. A survey of published articles in English that examine the influence of individual factors on the research utilization behaviour of nurses, without restriction of the study design, from selected computerized databases and hand searches.

Inclusion criteria. Articles had to measure one or more individual determinants of research utilization, measure the dependent variable (research utilization), and evaluate the relationship between the dependent and independent variables. The studies also had to indicate the direction of the relationship between the independent and dependent variables, report a P-value and the statistic used, and indicate the magnitude of the relationship.

Results. Six categories of potential individual determinants were identified: beliefs and attitudes, involvement in research activities, information seeking, professional characteristics, education and other socio-economic factors. Research design, sampling, measurement, and statistical analysis were examined to evaluate methodological quality. Methodological problems surfaced in all of the studies and, apart from attitude to research, there was little to suggest that any potential individual determinant influences research use.

Conclusion. Important conceptual and measurement issues with regard to research utilization could be better addressed if research in the area were undertaken longitudinally by multi-disciplinary teams of researchers.

Individual determinants of research utilization: a systematic review

The Cambridge Handbook of Age and Ageing, first published in 2005, is a guide to the body of knowledge, theory, policy and practice relevant to age researchers and gerontologists around the world. It contains almost 80 original chapters, commissioned and written by the world's leading gerontologists from 16 countries and 5 continents. The broad focus of the book is on the behavioural and social sciences but it also includes important contributions from the biological and medical sciences. It provides comprehensive, accessible and authoritative accounts of all the key topics in the field ranging from theories of ageing, to demography, physical aspects of ageing, mental processes and ageing, nursing and health care for older people, the social context of ageing, cross cultural perspectives, relationships, quality of life, gender, and financial and policy provision. This handbook will be a must-have resource for all researchers, students and professionals with an interest in age and ageing.

The Cambridge handbook of age and ageing

Transforming students' views of gerontological nursing: Realising the potential of 'enriched' environments of learning and care : A multi-method longitudinal study

'Making it better': self-perceived roles of family caregivers of older people living in care homes: a qualitative study.

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.

Promoting autonomy and independence for older people within nursing practice: a literature review

This paper reports on research commissioned by the English National Board for Nursing, Midwifery and Health Visiting into mentorship and clinical support arrangements for Project 2000 nursing students in the adult and mental health branches. Interviews and observation data were gathered from staff and students in three of the demonstration centres. Findings showed that the terms 'mentorship', 'assessor' and 'supervisor' were used interchangeably and covered diverse roles in both clinical and community settings. Generally there was an impression that staff were willing to help students learn from their experience but felt unprepared for the 'new nursing students'. Several factors emerged which seemed either to promote satisfactory experiences for students or inhibit their learning and enjoyment of the placement. These are discussed under the themes 'supernumerary status', 'team spirit', 'theory and practice', 'diploma level practice' and 'organization of nursing teams'.

Clinical support and the Project 2000 nursing student: factors influencing this process.

Despite the growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the care-giving career, relatively few British studies have explored this experience in depth. Informed by a constructivist perspective, this study sought a better understanding of nursing home placements from the viewpoint of relatives. Data were collected in 37 semi-structured inter- views involving 48 people who had assisted a close relative to move into a nursing home. Analysis revealed three perceived phases to the transition :  making the best of it ,  making the move  and  making it better . The relatives experiences through these phases had five perceived elements, all of which were continua, from absent to very strong, reflecting the extent to which they were felt. They were : operating  under pressure  or not ; in the know  or  working in the dark ;  working together  or working alone  ;  in control of events  or not, and  sup- ported  or unsupported  both practically and emotionally. This paper reports findings about the first phase of the transition, making the best of it , and documents the experiences of decision-making about nursing home placements. It is argued that health and social care practitioners have enormous potential to influence whether or not helping a relative to move into a nursing home is perceived as a positive choice.

/pdf/making-the-best-of-things-relatives-experiences-of-decisions-4k8hpeu3yk.pdf

Sue Davies

Papers

Transforming students' views of gerontological nursing: Realising the potential of 'enriched' environments of learning and care : A multi-method longitudinal study

'Making it better': self-perceived roles of family caregivers of older people living in care homes: a qualitative study.

Promoting autonomy and independence for older people within nursing practice: a literature review

Clinical support and the Project 2000 nursing student: factors influencing this process.

‘Making the best of things’: relatives' experiences of decisions about care-home entry