NursrEducorron 7’odq (1990) IO, 19>197 0 Longman Group UK Ltd 1990
The role of clinical supervision in the education of student psychiatric nurses: a theoretical approach Gary
Rolfe
A system of clinical supervision for student psychiatric nurses is suggested as an educational response to the rapidly changing role of the nurse. In addition to the small but expanding body of literature from the field of psychiatric nursing, research from social work, counselling, psychotherapy and teaching is also considered. A theoretical model is outlined in which supervision of students is by qualified and skilled practitioners. This is neither therapeutic nor didactic, but rather a ‘parallel process’ in which the supervisor-student relationship is employed as a tool to explore the student-client relationship and the therapeutic process.
INTRODUCTION psychiatric nursing becomes more specialised, and the nurse moves increasingly
As
towards the role of independent practitioner, there is a growing need for changes in the training of student psychiatric nurses. Already, in some schools of nursing, students are acquiring case loads of clients, and at least one hospital has abolished the system of ward placements, with students being allocated to clients rather than to clinical areas. This is the system in operation at St James’ Hospital in Portsmouth, where the students gradually pick up a caseload of eight to twelve clients during the period of their training. Students have full supernumary status and are not allocated to wards. Rather,
Gary Rolfe BSc MAlEd) RMN PGCEA Nurse Tutor, St James’ Hospital, Locksway Road, Portsmouth, Hants, Kquests for offprints to GR) Manuscript accepted 11 December
1989
they care for their clients wherever that care can be most appropriately given, be it on the ward, in a day hospital or in the community. A difficulty with this approach, however, is that it lacks the continuity and support structures of the traditional ward based system, with the students having no single identified person to whom they can turn for clinical guidance and help. One solution to this problem has been the introduction in some hospitals of a ‘mentor’ system, where student nurses are apprenticed to more experienced practitioners. However, as Watts (1986) points out, the mentoring has consisted mainly of informal relationships set up between mentor and ‘mentee’ which are then allowed to develop in their own way. What happens at St James’ Hospital goes beyond mentoring, being a more structured, formal approach aimed specifically at helping the student to acquire counselling and psychotherapeutic skills; namely, a system of supervision by practising psychiatric nurses. Although pioneered by Peplau and others in 193
1%
NURSE EDUCATION
the 1950s supervision
TODAl
has only recently re-emer-
ged as an area of consideration
for nurse educa-
tors. It is, however, an integral part of training in other
related
professions
counselling,
such as social work,
psychotherapy
and teaching.
Since
To
nurses,
something
however,
supervision
quite different.
tion by an administrative directs, controls,
superior
above,
often
nurse
training.
suggested contrast
the teacher’s
abilities’,
attempt
(1957) in she
role as one of listening
which,
the development as Platt-Koch
work in the psychiatric disciplines
(1986)
suggest a theoretical approach of student psychiatric nurses.
and
vision’
and
and is sometimes
(1988)
‘mentoring’
Ellis
and
with
(1987) a
to
to the supervision
While supervision
appear
form
of
this is by no means of supervision
clinical teaching
role.
To clarify these diverse uses of the concept, term
‘clinical
henceforth, elements
supervision’ and
will
be
taken
of this article,
vision in psychiatric formal
will be
process
nursing
whereby
more experienced
to
clinical
include Thus, super-
can be said to be a
a student
practitioner
and refine therapeutic
the
employed
from all the above definitions.
for the purposes
to
clinical
may well be part of
always the case, for some elements fall outside the traditional
‘super-
interchangeably,
Watson
supervision
confusing.
uses the terms
of
the recent
above,
Laurent
equate
connotations.
teaching.
field with that from the
mentioned
lacks rigour
Thus, whereas
who inspects,
the use of the term by theorists
the role of the clinical teacher,
with the role of the
to synthesise
In addition,
to
as we know it today’. Thus, an
will be made
related
Peplau
method of learning,
‘is consistent
clinical supervisor
psychiatric
didactic approach,
and enabling
out,
that a system of
when
an experiential
the student points
Indeed,
to the traditional
described ‘native
possible
may well enhance
(1986)
with ‘observa-
and evaluates the nurse’s work’
and thus often has negative
it is therefore
means
points out, it is usually associated
it could be argued that the psychiatric nurse must be proficient in the skills of all four of the formal supervision
often
As Platt-Koch
liases with a
in order to learn
skills through
the use of
case material.
A THEORETICAL PERSPECTIVE
Aims and roles in supervision Defining clinical supervision There
are many, often conflicting,
supervision. and Jones planned,
Thus, (1987)
see it as: periods of time that student spend together
student’s work in the placement the learning
of
in the social work field, Ford
regular
and supervisor
definitions
When examining
discussing
the
and reviewing
process.
In the training
of counsellors,
Brammer
and
Wassmer (1977) regard supervision as the assignment of an experienced person to help a beginner through similarly, supervision
the use of case material,
in psychotherapy
and
is an interaction
between two people, supervisor and supervisee, the aim of which is to develop or improve the supervisee’s psychotherapeutic skills through practice. Uackel, 1982)
the aims of clinical supervision
and the role of the supervisor, to borrow
from other
practice is more established. widespread acquisition
it is again helpful
professions
agreement of skills,
There
as to the goals of the knowledgeand self-
awareness by the student (Altucher ter et al 1972, Barber
in which the appears to be
& Norman
1967, Schus1987, Stuart &
Sundeen 1987), although there is some debate over the nature of the role of the supervisor. In a review of studies of social work supervision, Butler and Elliot (1985) found the three functions common
to them
helping and education. tion included workload
all to be management, The management funcallocation, the planning I
of placement experiences, assessment of performance and the authority element in relation to the student. The helping aspect included development of self awareness and insight, and prevention of undue stress; and the education
NURSE EDUCATION
component incorporated the notions of facilitation and of self directed learning, Pettes (1979) agreed with the above three functions and added a fourth, communication, without which, the other three become confused and chaotic. Turney et al (1982a, 1982b) indentified six roles of the supervisor of student teachers, manager, namely: counsellor, instructor, observer, provider of feedback and evaluator. Delaney and Moore (1966) surveyed beginning counselling students’ expectations of their supervisors and found that trainees expected their supervisors to direct their work, instruct them, demonstrate counselling techniques and provide support and security. Overall, they saw their supervisors in a teaching role, but did not want or expect much from them in terms of helpful interpersonal relationships. Walz and Roeber (1962) found that supervisors saw themselves in a role consistent with this view, but in practice actually functioned more as counsellors to their students. Neither the supervisors nor their students saw the management role as being important, and indeed, it could be argued that this role might impede the development of a trusting relationship.
THE PRACTICE OF CLINICAL SUPERVISION Education and counselling - A synthesis Clearly, there is a pressing need to resolve this role confusion, particularly the conflict between the supervisor as teacher and as emotional supporter. Arbuckle (1963) saw the relationship between supervisor and student as being identical to that of counsellor and client, a view supported by Altucher (1967), who claimed that: Learning to be a counsellor is both an emotional and an intellectual experience, and of the two, the emotional part is the most crucial. Halleck & Woods (1962), on the other hand, warn againsr the supervisor becoming a counsellor to his or her student, pointing out the potentially destructive forces that can result if
TODAY
1%
the supervisor is called upon to use his or her therapeutic skills in supervision. This point is reinforced by Vargus (1977), who is concerned about intra-psychic dependency, and by Jackel (1982), who believes that the supervisor should ‘retain the primacy of the teaching function’ and adds that any further gains are ‘desirable but serendipitous’. However, as Stuart and Sundeen (1987) indicate, all psychiatric nurses experience some degree of stress, adding that clinical supervision ‘provides the nurse with a system of clinical support and contributes greatly. . . to the quality of nursing care’. This point is echoed by Altucher (1967). who claims that the supervisor’s task is to manage the supervisee’s level of discomfort and anxiety at point high enough to produce the motivation for learning and yet low enough so that the student is not overwhelmed by the anxiety. Nevertheless, as several writers insist, supervision is not therapy, but neither is it strictly didactic. Rather, it falls between the two; it is ‘a relationship which is therapeutic, and in which the student learns’ (Patterson 1964), an ‘influencing situation’ directed towards certain changes in the student’s behaviour which are presumed to be therapeutic for clients. Kagan and Werner (1977) sum up this position when they write: the supervisor must work with the trainee on issues involving any of the trainee’s personal attributes which hinder his development as a therapist. In this sense, the task is similar to psychotherapy itself, but it has the important difference of being concerned primarily with the professional rather than personal aspects of the trainee’s life. Similarly, Reynolds (1985) and Hughes (1985) note the similarities between the supervision relationship and the nurse-client relationship, an observation that is given practical application by Stuart and Sundeen (1987). who see the process of supervision as being a special kind of in which the supervisorlearning situation student relationship is employed as a tool to examine the therapist-client relationship. Thus, the student comes to empathise with clients by
196
h’URSE EDUCATION
TODAY
experiencing a therapeutic-type relationship with his or her supervisor, the main difference being, as Ekstein and Wallerstein (1958) point out, that the focus is on learning and growth rather than psychotherapy. They have labelled this the ‘parallel process’, and go on to describe how the problems between supervisor and therapist often mirror those between therapist and client, and how gaining insight into the former can assist with working through the latter. This approach was supported in a study by Doehrman (1976), who concluded that the effective supervisor is one who deals with the supervisee’s feelings towards him or her and towards the supervisory process, and by Hansen and Barket (1964), who demonstrated that those trainee therapists who received the conditions of empathy, warmth, genuineness and unconditional regard from their supervisors become significantly more open to their own experiences, and are more successful in developing helpful behaviours in themselves. these Additionally, these studies confirmed Peplau’s (1957) assertion that the student must understand his or her own feelings and behaviour before being able to offer help to clients. From an educational perspective, then, the supervision session is a form of experiential learning in which the student experiences a theraupeutic relationship from the point of view of the client.
Who should supervise? A further question regarding the practice of clinical supervision is concerned with who is best suited to act as supervisors. It is argued in this article that in order to offer supervision of clinical practice, the supervisors must themselves be practising nurses. Reynolds (1985) suggested that supervision should be given by teachers working in a clinical setting, and in a later paper (Reynolds & Cormack 1987), argued strongly that the task should not go to practising nurses, ‘because these nurses may not have teaching skills or the time or motivation to teach. While this is undoubtedly the case with many nurses, it has been argued that the role of the clinical supervisor goes beyond teaching, and should
additionally involve counselling, support and possibly management. The decision as to who should supervise, then, involves striking a balance between the possession of teaching skills and therapeutic experience. Whereas nurse tutors may possess more of the former, Reynold’s (1985) suggestion that all tutors be engaged in practical psychiatric nursing is clearly still a long way from being realised. Furthermore, the logistic problems involved in every student in training being offered regular individual clinical supervision by the teaching staff may well be insurmountable. The solution adopted at St James’ Hospital relies mainly on practising staff nurses and ward sisters acting as supervisors after undergoing a short training course. Although they may not possess such developed teaching skills as tutors, they have a wealth of current clinical experience to draw upon, and many of them are able to offer specialist skills such as psychodrama or group therapy. Additionally, many students find it easier to build up a trusting relationship with someone to whom they are not managerially accountable.
CONCLUSION The use of clinical supervision is being proposed as an educational response to the changing role of the student psychiatric nurse, and as a practical and effective means of bridging the much discussed theory-practice gap. It is a concept which is employed differently, not only by different professions, but also within those professions. Thus, particularly when used in social work settings, supervision often has a large management component, whereas for student teachers, it appears to involve a great deal of assessment and didactic interaction. The model being proposed here for use with student psychiatric nurses is closer to the role of clinical supervision in the training of counsellors and psychotherapists. This is a well-tested method which has been refined over a period of very many years, and, as Platt-Koch (1986) points out: All of the mental health disciplines use clinical supervision as a major method of learning and
NURSE EDUCATION
relining
skills. simnlv L
because
,
learn how to interact
one
cannot
therapeutically
with a
solely by reading a book.
patient
It should be seen neither
method,
nor
as a didactic teaching
as a form
of therapy
for
the
student,
but as a process whereby the student’s relationship with his or her supervisor is
employed
as a teaching
therapeutic
relationship
aid
with
to explore
the
his or her clients in
process’.
a ‘parallel
Little attempt practical
has been made to address
problems
supervisory
of developing
the
a widespread
network. There are the questions as
to which staff would be eligible to be supervisors; would they require special training; themselves,
require
supervision
would they,
and
support;
and would they have enough time to give to their supervisees?
There
are also other,
more
theo-
retical questions,
such as: should the role of the include the task of ward-based assess-
sur>ervisor 1
merits; or should
the quasi-counselling
clinical supervision suggestion
of evaluation
Finally, Stuart that
experienced
much
as beginning
vision, state the
and that
and Sundeen students
to attempt
without adequate eludes nurse
from
(1986) to both
suggest
benefit just regular
goes the
as
super-
as far
as to
patient
and
to do psychiatric
clinical supervision’
treatment
and con-
‘supervision
is a valuable tool that the should use fully to develop the
therapist
professional role
(1987),
practitioners
Platt-Koch
by any
or assessment?
‘it is a disservice
nurse
role of
not be contaminated
self.
As nurses move closer to the
of independent
should take advantage
practitioner, perhaps they of each other’s skills and
utilise that ‘valuable tool’.
References Altucher N 1967 Constructive use of the supervisory relationship. Journal of Counselling Psychology 14:
165-70. Arbuckle D S 1963 The learning of counselling: process, not product. Journal of Counselling Psvcholocrv 10: 163-8 Barder P, I&man I 1987 Skills in supervision. Nursing Times. 83. 14th Ian. 56-7. Brammer L M, Wassmer A C 1977 Supervision in counselling and psychotherapy. In Kurpius D J, Baker R D, Thomas I D (Eds). Supervision of Applied Training. Greenwood Press, Westport, Connecticut. Butler B, Elliott D 1985 Teaching and learning for practice. Gower. Aldershot
TODAY
197
Delaney D 1, Moore J C 1966 Students expectations of the role of practicum supervisor. Coun&llor Education and Supervision 6: 11-l 7 Doehrman M 1976 Parallel process in supervision and psychotherapy. Bulletin of the Menninger Clinic 40,9 Ellis R, Watson C 1987 Experiential learning: the development of communication skills in a group therapy setting. Nurse Education Today 7: 215-221. Ekstein R, Wallerstein R 1958 The teaching and learning of psychotherapy. Basic Books, New York Ford K, Jones A 1987 Student Supervision. MacMillan, Basingstoke Halieck S L, Woods S M 1962 Emotional problems of psychiatric residents. Psychiatry 25: 339-46 Hansen J C 1965 Trainees expectations of supervision in thecounselling practicum. Counsellor Education and Supervision 2: 75-80 Hughes C 1985 Supervising clinical practice in psychological nursing. Journal of Psychosocial
Nursing 23: 27-32 Jackel M M 1982 Supervision in dynamic psychotherapy. In: Blumenfield M (Ed) Applied Supervision in Psychiatry. Grune and Stratton, New York Kagan N, Werner A 1977 Supervision in psychiatric education. In Kurpius D J, Barker R D, Thomas I D (Eds) Supervision of Applied Training. Greenwood Press, Westport, Connecticut Laurent C 1988 On hand to help. Nursing Times 84, 46: 29-30 Patterson C H 1964 Supervising students in the
counselling practicum. Journal of Counselling Psychology 11: 47-53 Peplau H E 1957 What is experiential teaching? America1 Journal of Nursing 57: 884-1886 Pettes D E 1979 Staff and student supervision. George Allen and Unwin, London Platt-Koch, L M 1986 Clinical supervision for psychiatric nurses. Journal of Psychosocial Nursing 26, 1: 7-15 Reynolds W 1985 Issues arising from teaching interpersonal skills in psychiatric nurse training. In: Kagan C (Ed) Nursing Education: research and developments. Croom Helm, London Reynolds W, Cormack D 1987 Teaching Psychiatric Nursing: interpersonal skills. In: Davis B (Ed) Nursing Education: research and developments Croom”Helm, London Schuster D B, Sandt J J, Thaler 0 F 1972 Clinical suoervision of the psvchiatric resident. Brunner/ Maze], New York * ’ Stuart G W, Sundeen S J 1987 Prnicples and practice of psychiatric nursing, 3rd ed. C V Mosby, St Louis, Missouri Turney C et al 1982a The practicum in teacher education. University Press, Sydney Turney C et al 1982b Supervisor development programmes. University Press, Sydney V&-g& I D 1977 Supervision in social work. In: Kurpius D 1, Baker R D, Thomas I D (Eds) Supervision of Applied Training. Greenwood Press, Westport, Connecticut Waltz G R, Roeher E C 1962 Supervisors reactions to a counselling interview. Counsellor Education and Supervision 1: 2-7 Watts A G 1986 Mentoring. Counselling 57. Aug: 4-7.
The role of clinical supervision in the education of student psychiatric nurses: a theoretical approach Gary
Rolfe
A system of clinical supervision for student psychiatric nurses is suggested as an educational response to the rapidly changing role of the nurse. In addition to the small but expanding body of literature from the field of psychiatric nursing, research from social work, counselling, psychotherapy and teaching is also considered. A theoretical model is outlined in which supervision of students is by qualified and skilled practitioners. This is neither therapeutic nor didactic, but rather a ‘parallel process’ in which the supervisor-student relationship is employed as a tool to explore the student-client relationship and the therapeutic process.
INTRODUCTION psychiatric nursing becomes more specialised, and the nurse moves increasingly
As
towards the role of independent practitioner, there is a growing need for changes in the training of student psychiatric nurses. Already, in some schools of nursing, students are acquiring case loads of clients, and at least one hospital has abolished the system of ward placements, with students being allocated to clients rather than to clinical areas. This is the system in operation at St James’ Hospital in Portsmouth, where the students gradually pick up a caseload of eight to twelve clients during the period of their training. Students have full supernumary status and are not allocated to wards. Rather,
Gary Rolfe BSc MAlEd) RMN PGCEA Nurse Tutor, St James’ Hospital, Locksway Road, Portsmouth, Hants, Kquests for offprints to GR) Manuscript accepted 11 December
1989
they care for their clients wherever that care can be most appropriately given, be it on the ward, in a day hospital or in the community. A difficulty with this approach, however, is that it lacks the continuity and support structures of the traditional ward based system, with the students having no single identified person to whom they can turn for clinical guidance and help. One solution to this problem has been the introduction in some hospitals of a ‘mentor’ system, where student nurses are apprenticed to more experienced practitioners. However, as Watts (1986) points out, the mentoring has consisted mainly of informal relationships set up between mentor and ‘mentee’ which are then allowed to develop in their own way. What happens at St James’ Hospital goes beyond mentoring, being a more structured, formal approach aimed specifically at helping the student to acquire counselling and psychotherapeutic skills; namely, a system of supervision by practising psychiatric nurses. Although pioneered by Peplau and others in 193
1%
NURSE EDUCATION
the 1950s supervision
TODAl
has only recently re-emer-
ged as an area of consideration
for nurse educa-
tors. It is, however, an integral part of training in other
related
professions
counselling,
such as social work,
psychotherapy
and teaching.
Since
To
nurses,
something
however,
supervision
quite different.
tion by an administrative directs, controls,
superior
above,
often
nurse
training.
suggested contrast
the teacher’s
abilities’,
attempt
(1957) in she
role as one of listening
which,
the development as Platt-Koch
work in the psychiatric disciplines
(1986)
suggest a theoretical approach of student psychiatric nurses.
and
vision’
and
and is sometimes
(1988)
‘mentoring’
Ellis
and
with
(1987) a
to
to the supervision
While supervision
appear
form
of
this is by no means of supervision
clinical teaching
role.
To clarify these diverse uses of the concept, term
‘clinical
henceforth, elements
supervision’ and
will
be
taken
of this article,
vision in psychiatric formal
will be
process
nursing
whereby
more experienced
to
clinical
include Thus, super-
can be said to be a
a student
practitioner
and refine therapeutic
the
employed
from all the above definitions.
for the purposes
to
clinical
may well be part of
always the case, for some elements fall outside the traditional
‘super-
interchangeably,
Watson
supervision
confusing.
uses the terms
of
the recent
above,
Laurent
equate
connotations.
teaching.
field with that from the
mentioned
lacks rigour
Thus, whereas
who inspects,
the use of the term by theorists
the role of the clinical teacher,
with the role of the
to synthesise
In addition,
to
as we know it today’. Thus, an
will be made
related
Peplau
method of learning,
‘is consistent
clinical supervisor
psychiatric
didactic approach,
and enabling
out,
that a system of
when
an experiential
the student points
Indeed,
to the traditional
described ‘native
possible
may well enhance
(1986)
with ‘observa-
and evaluates the nurse’s work’
and thus often has negative
it is therefore
means
points out, it is usually associated
it could be argued that the psychiatric nurse must be proficient in the skills of all four of the formal supervision
often
As Platt-Koch
liases with a
in order to learn
skills through
the use of
case material.
A THEORETICAL PERSPECTIVE
Aims and roles in supervision Defining clinical supervision There
are many, often conflicting,
supervision. and Jones planned,
Thus, (1987)
see it as: periods of time that student spend together
student’s work in the placement the learning
of
in the social work field, Ford
regular
and supervisor
definitions
When examining
discussing
the
and reviewing
process.
In the training
of counsellors,
Brammer
and
Wassmer (1977) regard supervision as the assignment of an experienced person to help a beginner through similarly, supervision
the use of case material,
in psychotherapy
and
is an interaction
between two people, supervisor and supervisee, the aim of which is to develop or improve the supervisee’s psychotherapeutic skills through practice. Uackel, 1982)
the aims of clinical supervision
and the role of the supervisor, to borrow
from other
practice is more established. widespread acquisition
it is again helpful
professions
agreement of skills,
There
as to the goals of the knowledgeand self-
awareness by the student (Altucher ter et al 1972, Barber
in which the appears to be
& Norman
1967, Schus1987, Stuart &
Sundeen 1987), although there is some debate over the nature of the role of the supervisor. In a review of studies of social work supervision, Butler and Elliot (1985) found the three functions common
to them
helping and education. tion included workload
all to be management, The management funcallocation, the planning I
of placement experiences, assessment of performance and the authority element in relation to the student. The helping aspect included development of self awareness and insight, and prevention of undue stress; and the education
NURSE EDUCATION
component incorporated the notions of facilitation and of self directed learning, Pettes (1979) agreed with the above three functions and added a fourth, communication, without which, the other three become confused and chaotic. Turney et al (1982a, 1982b) indentified six roles of the supervisor of student teachers, manager, namely: counsellor, instructor, observer, provider of feedback and evaluator. Delaney and Moore (1966) surveyed beginning counselling students’ expectations of their supervisors and found that trainees expected their supervisors to direct their work, instruct them, demonstrate counselling techniques and provide support and security. Overall, they saw their supervisors in a teaching role, but did not want or expect much from them in terms of helpful interpersonal relationships. Walz and Roeber (1962) found that supervisors saw themselves in a role consistent with this view, but in practice actually functioned more as counsellors to their students. Neither the supervisors nor their students saw the management role as being important, and indeed, it could be argued that this role might impede the development of a trusting relationship.
THE PRACTICE OF CLINICAL SUPERVISION Education and counselling - A synthesis Clearly, there is a pressing need to resolve this role confusion, particularly the conflict between the supervisor as teacher and as emotional supporter. Arbuckle (1963) saw the relationship between supervisor and student as being identical to that of counsellor and client, a view supported by Altucher (1967), who claimed that: Learning to be a counsellor is both an emotional and an intellectual experience, and of the two, the emotional part is the most crucial. Halleck & Woods (1962), on the other hand, warn againsr the supervisor becoming a counsellor to his or her student, pointing out the potentially destructive forces that can result if
TODAY
1%
the supervisor is called upon to use his or her therapeutic skills in supervision. This point is reinforced by Vargus (1977), who is concerned about intra-psychic dependency, and by Jackel (1982), who believes that the supervisor should ‘retain the primacy of the teaching function’ and adds that any further gains are ‘desirable but serendipitous’. However, as Stuart and Sundeen (1987) indicate, all psychiatric nurses experience some degree of stress, adding that clinical supervision ‘provides the nurse with a system of clinical support and contributes greatly. . . to the quality of nursing care’. This point is echoed by Altucher (1967). who claims that the supervisor’s task is to manage the supervisee’s level of discomfort and anxiety at point high enough to produce the motivation for learning and yet low enough so that the student is not overwhelmed by the anxiety. Nevertheless, as several writers insist, supervision is not therapy, but neither is it strictly didactic. Rather, it falls between the two; it is ‘a relationship which is therapeutic, and in which the student learns’ (Patterson 1964), an ‘influencing situation’ directed towards certain changes in the student’s behaviour which are presumed to be therapeutic for clients. Kagan and Werner (1977) sum up this position when they write: the supervisor must work with the trainee on issues involving any of the trainee’s personal attributes which hinder his development as a therapist. In this sense, the task is similar to psychotherapy itself, but it has the important difference of being concerned primarily with the professional rather than personal aspects of the trainee’s life. Similarly, Reynolds (1985) and Hughes (1985) note the similarities between the supervision relationship and the nurse-client relationship, an observation that is given practical application by Stuart and Sundeen (1987). who see the process of supervision as being a special kind of in which the supervisorlearning situation student relationship is employed as a tool to examine the therapist-client relationship. Thus, the student comes to empathise with clients by
196
h’URSE EDUCATION
TODAY
experiencing a therapeutic-type relationship with his or her supervisor, the main difference being, as Ekstein and Wallerstein (1958) point out, that the focus is on learning and growth rather than psychotherapy. They have labelled this the ‘parallel process’, and go on to describe how the problems between supervisor and therapist often mirror those between therapist and client, and how gaining insight into the former can assist with working through the latter. This approach was supported in a study by Doehrman (1976), who concluded that the effective supervisor is one who deals with the supervisee’s feelings towards him or her and towards the supervisory process, and by Hansen and Barket (1964), who demonstrated that those trainee therapists who received the conditions of empathy, warmth, genuineness and unconditional regard from their supervisors become significantly more open to their own experiences, and are more successful in developing helpful behaviours in themselves. these Additionally, these studies confirmed Peplau’s (1957) assertion that the student must understand his or her own feelings and behaviour before being able to offer help to clients. From an educational perspective, then, the supervision session is a form of experiential learning in which the student experiences a theraupeutic relationship from the point of view of the client.
Who should supervise? A further question regarding the practice of clinical supervision is concerned with who is best suited to act as supervisors. It is argued in this article that in order to offer supervision of clinical practice, the supervisors must themselves be practising nurses. Reynolds (1985) suggested that supervision should be given by teachers working in a clinical setting, and in a later paper (Reynolds & Cormack 1987), argued strongly that the task should not go to practising nurses, ‘because these nurses may not have teaching skills or the time or motivation to teach. While this is undoubtedly the case with many nurses, it has been argued that the role of the clinical supervisor goes beyond teaching, and should
additionally involve counselling, support and possibly management. The decision as to who should supervise, then, involves striking a balance between the possession of teaching skills and therapeutic experience. Whereas nurse tutors may possess more of the former, Reynold’s (1985) suggestion that all tutors be engaged in practical psychiatric nursing is clearly still a long way from being realised. Furthermore, the logistic problems involved in every student in training being offered regular individual clinical supervision by the teaching staff may well be insurmountable. The solution adopted at St James’ Hospital relies mainly on practising staff nurses and ward sisters acting as supervisors after undergoing a short training course. Although they may not possess such developed teaching skills as tutors, they have a wealth of current clinical experience to draw upon, and many of them are able to offer specialist skills such as psychodrama or group therapy. Additionally, many students find it easier to build up a trusting relationship with someone to whom they are not managerially accountable.
CONCLUSION The use of clinical supervision is being proposed as an educational response to the changing role of the student psychiatric nurse, and as a practical and effective means of bridging the much discussed theory-practice gap. It is a concept which is employed differently, not only by different professions, but also within those professions. Thus, particularly when used in social work settings, supervision often has a large management component, whereas for student teachers, it appears to involve a great deal of assessment and didactic interaction. The model being proposed here for use with student psychiatric nurses is closer to the role of clinical supervision in the training of counsellors and psychotherapists. This is a well-tested method which has been refined over a period of very many years, and, as Platt-Koch (1986) points out: All of the mental health disciplines use clinical supervision as a major method of learning and
NURSE EDUCATION
relining
skills. simnlv L
because
,
learn how to interact
one
cannot
therapeutically
with a
solely by reading a book.
patient
It should be seen neither
method,
nor
as a didactic teaching
as a form
of therapy
for
the
student,
but as a process whereby the student’s relationship with his or her supervisor is
employed
as a teaching
therapeutic
relationship
aid
with
to explore
the
his or her clients in
process’.
a ‘parallel
Little attempt practical
has been made to address
problems
supervisory
of developing
the
a widespread
network. There are the questions as
to which staff would be eligible to be supervisors; would they require special training; themselves,
require
supervision
would they,
and
support;
and would they have enough time to give to their supervisees?
There
are also other,
more
theo-
retical questions,
such as: should the role of the include the task of ward-based assess-
sur>ervisor 1
merits; or should
the quasi-counselling
clinical supervision suggestion
of evaluation
Finally, Stuart that
experienced
much
as beginning
vision, state the
and that
and Sundeen students
to attempt
without adequate eludes nurse
from
(1986) to both
suggest
benefit just regular
goes the
as
super-
as far
as to
patient
and
to do psychiatric
clinical supervision’
treatment
and con-
‘supervision
is a valuable tool that the should use fully to develop the
therapist
professional role
(1987),
practitioners
Platt-Koch
by any
or assessment?
‘it is a disservice
nurse
role of
not be contaminated
self.
As nurses move closer to the
of independent
should take advantage
practitioner, perhaps they of each other’s skills and
utilise that ‘valuable tool’.
References Altucher N 1967 Constructive use of the supervisory relationship. Journal of Counselling Psychology 14:
165-70. Arbuckle D S 1963 The learning of counselling: process, not product. Journal of Counselling Psvcholocrv 10: 163-8 Barder P, I&man I 1987 Skills in supervision. Nursing Times. 83. 14th Ian. 56-7. Brammer L M, Wassmer A C 1977 Supervision in counselling and psychotherapy. In Kurpius D J, Baker R D, Thomas I D (Eds). Supervision of Applied Training. Greenwood Press, Westport, Connecticut. Butler B, Elliott D 1985 Teaching and learning for practice. Gower. Aldershot
TODAY
197
Delaney D 1, Moore J C 1966 Students expectations of the role of practicum supervisor. Coun&llor Education and Supervision 6: 11-l 7 Doehrman M 1976 Parallel process in supervision and psychotherapy. Bulletin of the Menninger Clinic 40,9 Ellis R, Watson C 1987 Experiential learning: the development of communication skills in a group therapy setting. Nurse Education Today 7: 215-221. Ekstein R, Wallerstein R 1958 The teaching and learning of psychotherapy. Basic Books, New York Ford K, Jones A 1987 Student Supervision. MacMillan, Basingstoke Halieck S L, Woods S M 1962 Emotional problems of psychiatric residents. Psychiatry 25: 339-46 Hansen J C 1965 Trainees expectations of supervision in thecounselling practicum. Counsellor Education and Supervision 2: 75-80 Hughes C 1985 Supervising clinical practice in psychological nursing. Journal of Psychosocial
Nursing 23: 27-32 Jackel M M 1982 Supervision in dynamic psychotherapy. In: Blumenfield M (Ed) Applied Supervision in Psychiatry. Grune and Stratton, New York Kagan N, Werner A 1977 Supervision in psychiatric education. In Kurpius D J, Barker R D, Thomas I D (Eds) Supervision of Applied Training. Greenwood Press, Westport, Connecticut Laurent C 1988 On hand to help. Nursing Times 84, 46: 29-30 Patterson C H 1964 Supervising students in the
counselling practicum. Journal of Counselling Psychology 11: 47-53 Peplau H E 1957 What is experiential teaching? America1 Journal of Nursing 57: 884-1886 Pettes D E 1979 Staff and student supervision. George Allen and Unwin, London Platt-Koch, L M 1986 Clinical supervision for psychiatric nurses. Journal of Psychosocial Nursing 26, 1: 7-15 Reynolds W 1985 Issues arising from teaching interpersonal skills in psychiatric nurse training. In: Kagan C (Ed) Nursing Education: research and developments. Croom Helm, London Reynolds W, Cormack D 1987 Teaching Psychiatric Nursing: interpersonal skills. In: Davis B (Ed) Nursing Education: research and developments Croom”Helm, London Schuster D B, Sandt J J, Thaler 0 F 1972 Clinical suoervision of the psvchiatric resident. Brunner/ Maze], New York * ’ Stuart G W, Sundeen S J 1987 Prnicples and practice of psychiatric nursing, 3rd ed. C V Mosby, St Louis, Missouri Turney C et al 1982a The practicum in teacher education. University Press, Sydney Turney C et al 1982b Supervisor development programmes. University Press, Sydney V&-g& I D 1977 Supervision in social work. In: Kurpius D 1, Baker R D, Thomas I D (Eds) Supervision of Applied Training. Greenwood Press, Westport, Connecticut Waltz G R, Roeher E C 1962 Supervisors reactions to a counselling interview. Counsellor Education and Supervision 1: 2-7 Watts A G 1986 Mentoring. Counselling 57. Aug: 4-7.
