Restorative clinical supervision: a chance for change but are we ready?

In the wake of the COVID-19 pandemic, nurses are experiencing increasing stress, burnout and mental health problems. The Advocating and Educating for Quality ImProvement (A-EQUIP) model of clinical supervision aims to support staff wellbeing, promote positive work cultures and improve patient care. Although a growing body of empirical evidence supports the positive impact of clinical supervision, several individual and organisational barriers may impede the implementation of A-EQUIP in practice. Organisational culture, staffing and workforce pressures all affect employees' ability to engage with supervision, and organisations and clinical leaders must consciously work to sustain lasting change.

Thinking Outside the Box: Advancing Clinical Education in an Era of Preceptor Shortage.

ABSTRACT: The expansion of health professions educational programs has led to an acute shortage of available clinical training sites. Rapid growth in the number of medical schools, physician assistant (PA) programs, and advanced nurse practitioner (APRN) programs, all of which share a need for similar types of clinical training experiences, has increased competition for clinical training sites and placed new challenges on educational institutions. Solutions are urgently needed to increase the quantity and quality of supervised clinical practice experiences as well as to ensure diversity among preceptors and geographical clinical sites. This article identifies key barriers to securing sufficient clinical training sites, notes emerging trends, and presents potential innovations through stakeholder collaboration for enhancing clinical training across health professions.

Cultivating support during COVID-19 through clinical supervision: A discussion article.

AIM: This article aims to discuss how clinical supervision is an important approach in supporting frontline nurses and students during and post COVID-19 through the lens of the nursing metaparadigms. DESIGN: Discussion article. METHODS: Discourse of the literature considering the importance of working collaboratively with healthcare and educational organisations in operationalising clinical supervision. RESULTS: The evidence base supporting clinical supervision as an effective support strategy for nurses exists, however, its implementation and practice has become sporadic. A resurgence is required to support student's and nurse's during this pandemic. It is timely for nurse educators to creatively engage with clinical partners in supporting clinical supervision to enhance both nurses and students pandemic practice experiences. Clinical supervision is proposed as one strategy to support and guide both nurses and students to develop, strengthen and challenge the effectiveness of their care during COVID-19.

The COVID-19 e-lective: using innovation to manage disrupted medical student clinical placements.

BACKGROUND: The COVID-19 pandemic changed the way we work, spend, live, and learn. The impact was felt in the health sector where hospitals cancelled elective surgery, put on hold outpatient services, and implemented new social distancing procedures and telehealth systems, to enable hospitals to increase bed capacity. For medical students, these factors meant significant disruption to their clinical placements, remote delivery of their education, cessation of international and interstate placements, complicated by significant travel restrictions and border closures. There were concerns that final year students might be unable to graduate that year due to this lack of clinical exposure. INNOVATION: As a result of this disruption in late March 2020 we developed an innovative 6 week 'COVID-19 e-lective' rotation, consisting of online modules, virtual clinical tutorials and a COVID project totalling the equivalent of 200 h of work. RESULTS: An evaluation was undertaken that found it to be remarkably successful in meeting the students' learning needs and alleviating concerns about disrupted placements. It was also conducted during 2021 for all Year 4 students to help expand clinical placement opportunities. OUTCOMES: This paper describes the e-lective, its innovations, its challenges, and its evaluation findings, for others to learn from.

Nursing students' achievement emotions in association with clinical practicums and alternative learning.

OBJECTIVES: This study aimed to identify and compare nursing students' achievement emotions associated with clinical practicums and alternative learning during the COVID-19 pandemic. METHODS: This cross-sectional, descriptive study enrolled 236 nursing students. Participants completed a web-based, self-administered survey regarding achievement emotions. Wilcoxon signed-rank tests were used to calculate mean differences in achievement emotions associated with clinical practicums and alternative learning. RESULTS: Nursing students who undertook e-learning reported higher negative achievement emotions than those who experienced other alternative learning modalities. Higher achievement emotions were associated with clinical practicums than with alternative learning. The most frequently reported negative emotions were anxiety associated with clinical practicums and boredom with alternative learning. CONCLUSIONS: Nurse educators should design and implement supportive clinical learning experiences to engender productive achievement emotions. Implications for an international audience: Nurse educators should play roles in providing well-designed and supportive clinical learning environments to help nursing students regulate achievement emotions.

Excellence in Nursing Preceptorship-to-Hire, part 1.

An academic-practice partnership to recruit and retain nurses.

Stakeholder perceptions of the efficacy, barriers, and facilitators of telemental health clinical experiences during COVID for nurse practitioner students.

BACKGROUND: Telemental health services grew during the COVID pandemic, resulting in psychiatric-mental health nurse practitioner students obtaining clinical hours through this modality. Although patient outcome data demonstrate the efficacy of telemental health services, data on the efficacy of learning through telehealth clinical experiences are lacking. PURPOSE: To explore perceptions of learning through telehealth clinical experiences by students, preceptors, and faculty and to identify perceived barriers and facilitators to facilitating telehealth clinical experiences. METHODOLOGY: Mixed-methods exploratory study using web-based, researcher-designed, cross-sectional surveys eliciting perceptions of learning and perceived barriers and facilitators to telemental health clinical experiences sent to current and former PMHNP students and their preceptors of a state university in the southwest along with PMHNP faculty in the National Organization of Nurse Practitioner Faculties. Students and preceptors were offered the option to participate in a semistructured interview. RESULTS: Twenty students (35.7%), 22 preceptors (24.7%), and 19 faculty (25.3%) participated in the surveys. Three preceptors and three students volunteered for interviews. Telemental health clinicals were perceived by students as equivalent to or superior to in-person learning. Preceptors rated the teaching/learning environment through telemental health as equivalent or better as compared with in-person clinicals with two exceptions. Faculty-rated greatest barrier to telemental health clinicals was telephone visits because of technology issues. CONCLUSIONS: Telemental health clinicals can provide a high-quality learning experience for students. IMPLICATIONS: Preceptors should be provided with resources for facilitating telemental health clinicals. Ongoing discussions regarding the number of clinical hours recommended through telehealth are needed.

Supporting nursing, midwifery and allied health professional teams through restorative clinical supervision.

The mental health and wellbeing of healthcare staff have been significantly affected by the demands resulting from the recent COVID-19 pandemic. Restorative supervision is a type of clinical supervision that supports reflective practice that can help build practitioners' resilience by focusing on the individual's experience, aiming to sustain their wellbeing and their motivation at work. This model has been shown to reduce stress and burnout and increase compassion satisfaction. This article discusses the implementation of a restorative clinical supervision programme used to support staff wellbeing in nursing, midwifery and allied health professional teams in a large London-based NHS trust.

Preceptor support during the COVID-19 pandemic: Recommendations for continuing development.

BACKGROUND:  Mentally fit preceptors may be more capable and flexible in providing students with system, emotional and cognitive support in the clinical learning environment (CLE) in the face of any life-threatening outbreaks. Existing professional development programmes for preceptors emphasise the development of preceptor competence in a normal CLE with minimal focus on their ability to engage with adverse events that challenge their mental health. OBJECTIVE:  The study sought insight from preceptors' experiences during the coronavirus disease 2019 (COVID-19) pandemic to identify their professional development programme needs while providing support to students during accompaniment. METHOD:  A mixed methods convergent parallel design was used to collect data from 24 preceptors at a nursing education institution (NEI). Eleven preceptors responded to the survey that included the coronavirus disease 2019 (COVID-19) Stress Scale (CSS) and Burnout Assessment Tool (BAT) to collect quantitative data. Semistructured interviews were conducted with five purposively selected preceptors to collect qualitative data regarding their experiences while accompanying students during the COVID-19 pandemic. RESULTS:  Subscales within the CSS and BAT instruments were mapped against an existing preceptor support framework. Overall CSS data for each subscale indicated an average score varying from no stress to moderate stress, while BAT data shows that respondents rarely experienced burnout. However, some respondents experienced very high levels of stress and burnout. Qualitative data supplemented results. CONCLUSION:  The COVID-19 pandemic influenced preceptors' role in supporting students and reflecting that they amended their functioning role. Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.Contribution: Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.

Experiences of first year undergraduate nursing students using Instagram in their clinical practicum during COVID-19 pandemic: A qualitative study.

BACKGROUND: Social media provides us with easy access to information. For students, it is an additional learning resource used in different types of theoretical and practical teaching methodologies. OBJECTIVES: The aim of this paper was to describe the perspective of undergraduate nursing students on the use of Instagram during their clinical practicums in the midst of the COVID-19 pandemic. DESIGN: A qualitative descriptive and exploratory study based on an interpretative framework. SETTINGS AND PARTICIPANTS: First-year undergraduate nursing students at the Universidad Europea de Madrid were included. METHODS: In-depth interviews and researchers' field notes were used to collect the data. Purposive sampling and inductive thematic analysis were applied. During the interviews, themes such as accompaniment during practicums or training opportunities were identified. RESULTS: The use of Instagram helped students to feel closer to professors, identifying it as an opportunity to remedy the possible lack of connection between theory and practice. Moreover, Instagram helped them build an image of nursing in clinical practicum environments. By using Instagram, undergraduate nursing students were able to better integrate and apply the knowledge acquired at university during their clinical practicums in hospitals. CONCLUSIONS: Our results can be applied to future studies on the use of social media platforms as teaching tools in clinical practicum settings and to observe the evolution of the image and role of nursing and its relationship with social media.

The Impact of COVID-19 on the Clinical Experience and Training of Undergraduate Student Radiographers internationally: The Clinical Tutors' perspective.

INTRODUCTION: The impact on the clinical training and education of healthcare students by COVID-19 has been documented. However, the thoughts and experiences of clinical tutors (CTs) about radiography students attending for clinical training and education during this now elongated period beyond first recognition of the virus has not been explored. This paper will discuss data collected from CTs in the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) who were compared because of their similarities in delivery based on individual 'rules of engagement' devised by their various health departments. AIM: The purpose of this study was to examine the clinical tutors' thoughts and experiences of supervising radiography students attending clinical placement during the COVID-19 pandemic. METHODS: The UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) were selected for comparison on an international level as they are geographically distinct with a comparable population and education accredited/acknowledged by the Society and College of Radiographers (SCoR). Data was collected data from CTs across the UKDN and the UAE. The study used an online questionnaire (Google Forms) with closed questions in four themes including: students' experiences, impact on students' clinical placement, attitude of the clinical staff and the potential effects of COVID-19 on future graduates' skills and competencies. Further data was gathered on the experience of CTs mentoring students during the COVID-19 pandemic. RESULTS: Data were collected from 59 CTs (81%, n = 48) from UKDN and (19%, n = 11) UAE. Twenty-seven (46%) respondents reported that COVID-19 had a negative impact on clinical practical experience. However, 32 (54%) identified that COVID-19 had no impact on student supervision/feedback or on clinical achievements. Eleven (19%) respondents thought that students should not have been on clinical placement during the pandemic but a further 51% (n = 30) were happy with the students on placement and expressed willingness to delegate work to students. Interestingly, 58% (n = 34) of CTs suggested that future graduates may need a longer preceptorship after they graduate due to receiving decreased clinical experience during the pandemic. Overall, 78% (n = 46) of respondents thought that students improved their clinical confidence by working directly with COVID-19 positive patients. CONCLUSION: The current study has identified conflicting opinions across CTs in different clinical departments. Whilst some felt that students should not be in the hospital during the pandemic, others reported that working directly with COVID-19 patients had a positive impact on students as it improved their clinical confidence. Despite the challenges presented by COVID-19, CTs were able to provide direct clinical supervision and feedback to students on clinical placement throughout the pandemic. Nevertheless, future graduates may need a longer preceptorship period due to decreased clinical experience during the pandemic. IMPLICATIONS FOR PRACTICE: Clinical placements should continue during subsequent COVID-19 waves of infection or future pandemics to ensure development of skills in resilience and adaptability. Underdeveloped skills due to a decreased range of examinations can be rectified when any wave of the infection subsides by providing tailored training based on individual student's needs.

A rapid review of the impact of COVID-19 on clinical supervision practices of healthcare workers and students in healthcare settings.

AIMS: To synthesize available data on the impact of the COVID-19 pandemic on clinical supervision practices of healthcare workers and students in healthcare settings. DESIGN: A quantitative rapid review of the literature. DATA SOURCES: A search of MEDLINE, Embase, PsycINFO, the Cochrane Library and Scopus for English language papers published between December 2019 (initial onset of the pandemic) to March 2021. REVIEW METHODS: Using the World Health Organization and Cochrane guidelines for rapid reviews, following an identification of relevant papers and data extraction, a narrative synthesis approach was used to develop themes. RESULTS: Eight studies met the inclusion criteria. Four themes identified from data synthesis were nature and extent of disruptions to clinical supervision, unmet need for psychological support, supervisors also need support and unpacking telesupervision. Findings highlight the extent and nature of disruption to clinical supervision at the point of care. Further information on factors that facilitate high-quality telesupervision have come to light. CONCLUSION: The COVID-19 pandemic has placed tremendous burden on healthcare workers compromising their own health and well-being. It is essential to restore effective clinical supervision practices at the point of care, so as to enhance patient, healthcare worker and organizational outcomes into the post-COVID-19 pandemic period. IMPACT: This review has provided initial evidence on the adverse impacts of the COVID-19 pandemic on clinical supervision of healthcare workers and students at the point of care. Available evidence indicates the urgent need to restore effective and high-quality clinical supervision practices in health settings. The review has highlighted a paucity of studies in this area, calling for further high-quality studies.

Development and Validation of a Clinical Practicum Assessment Tool for the NAACLS-Accredited Biomedical Science Program.

Student perspectives on their final year clinical placements in biomedical sciences at Qatar University are assessed using the clinical practicum assessment tool (CPAT), which was developed in-house following accreditation body requirements. The tool, which we call the CPAT-Qatar University (CPAT-QU), covers the three clinical practicum domains: practicum content, preceptors, and competencies. Here, we validate this tool. The CPAT-QU has 27 Likert-scale questions and free-text open questions. CPAT-QU readability was calculated using the Flesch-Kincaid Reading Ease (FKRE) instrument. Content validity was assessed using the average and universal average scale-level content validity indices (S-CVI/Average and S-CVI/UA). For construct validity, 50 employed graduates who had completed the practicum were consented for study participation, and the validity was calculated by a principal component analysis (PCA). Reliability was analyzed by Cronbach's alpha. The S-CVI/Average and S-CVI/UA were 0.90 and 0.59, respectively, indicating that an adequate proportion of the content was relevant. The PCA extracted two core components, which explained 63% of the variance in the CPAT-QU. Cronbach's alpha values for the items were within the acceptable range of 0.60-1.00, showing that internal consistency has a good level. CPAT-QU appears to be a useful tool for assessing student perspectives on their clinical placements; however, construct validity needs continuous improvement.

Rebooting effective clinical supervision practices to support healthcare workers through and following the COVID-19 pandemic.

The importance of clinical supervision, a professional support and clinical governance mechanism, to patients, healthcare workers and organizations has been well documented. Clinical supervision has been shown to support healthcare workers during challenging times, by reducing burnout, enhancing mental health and wellbeing at work, and improving job satisfaction. However, clinical supervision participation and effectiveness are pre-requisites for realising these benefits. During times of stress and increased workloads (e.g. during the Coronavirus pandemic), healthcare workers tend to prioritise clinical duties and responsibilities over clinical supervision. Effective supervision practices can be restored, and healthcare workers can be better supported in their roles during and in the post-pandemic period only if healthcare workers, policy makers, healthcare organizations, clinical supervision trainers and researchers join forces. This paper sheds light on this important topic and offers a number of practical recommendations to reboot effective clinical supervision practices at the point of care.

Initiation of a New Nurse Preceptor Program in the Era of COVID-19.

COVID-19 has impacted most hospitals around the world, resulting in changes to daily operations and the suspension of some programs. Preceptor training is an area that has been impacted by COVID-19 restrictions. These programs have a positive impact on the retention of new RNs, which is especially important as the pandemic continues to strain morale. A 12-week, step-by-step education plan that leverages audio/video technologies such as Zoom and FaceTime was developed to preserve the positive benefits of the preceptor-preceptee relationship in the setting of COVID-19. [J Contin Educ Nurs. 2022;53(5):221-224.].

Impact of the COVID-19 Pandemic on Clinical Supervision of Healthcare Students in Rural Settings: A Qualitative Study.

The COVID-19 pandemic has caused significant disruptions to healthcare student placements worldwide, including already challenged rural areas in Australia. While accounts are emerging of student experiences in larger centers and from a student perspective, there is a need for in-depth exploration of student supervisor experiences in rural areas at the onset of the pandemic. This study aims to address this gap through 23 individual, semi-structured interviews with healthcare workers from ten health professions who were either direct student supervisors or in roles supporting student supervisors A reflexive thematic analysis approach was used to develop four themes, namely compounding stress, negative impacts on student learning, opportunity to flex and innovate, and targeted transitioning support strategies. The findings indicate that healthcare workers with student supervision responsibilities at the onset of the pandemic experienced high levels of stress and wellbeing concerns. This study sheds light on the importance of supporting student supervisors in rural areas, and the need for implementing targeted support strategies for new graduates whose placements were impacted by the pandemic. This is not only essential for supporting the rural healthcare workforce but is also imperative for addressing inequalities to healthcare access experienced in rural communities.

Enhancing the well-being of front-line healthcare professionals in high pressure clinical environments: A mixed-methods evaluative research project.

BACKGROUND: The last few years have witnessed a growing concern with the well-being of healthcare professionals internationally because of increasing recognition of its impact on patient outcomes and staff retention. The COVID-19 pandemic, which has placed additional and substantial pressure on frontline healthcare professionals, gives added urgency to the topic. While numerous, and successful, interventions have been developed to address compromised well-being among healthcare professionals, they have not always been able to support the needs of frontline staff, specifically those working in high-pressure environments. OBJECTIVE: This paper presents findings of an evaluative research study of an intervention, named the Resilience and Well-being Training Programme, developed and implemented within an Acute Assessment Unit in a hospital in the UK. The 8 week-long programme followed a combined approach (both person-directed and work-directed), with mindfulness training as well as lectures and discussions to deepen participants' understanding of organisational life. The training, delivered from January to July 2018, involved a total of 72 healthcare professionals from a wide range of levels (UK bands 2-8), trained in three cohorts. DESIGN: The research followed a pre-post design to explore participants' experiences of working on the Unit, the programme and its impact on themselves and their working life. SETTING: The study was conducted in a large NHS district general hospital in South London, UK. PARTICIPANTS: Participants included healthcare assistants and nurses who had completed their preceptorship, worked in the hospital's acute assessment unit, and had undertaken the resilience and well-being training programme. METHODS: The study employed mixed methods (online questionnaire, face-to-face focus groups/interviews) to collect data. RESULTS: Findings showed participants' positive experience with the programme, however it had limited positive impacts on aspects of compromised well-being at the personal level and a statistically significant enhancement of the quality of relationships and communication on the Unit, with medium effect size (Cohen's D). The programme had a positive impact on the culture of the Unit. CONCLUSIONS: Results highlight the demand for and value of programmes designed in ways that enable this group of professionals to take part, because these professionals are often not able to participate in such programmes. A strong commitment from the leadership to enable staff attendance in time-protected programmes is one approach that works well in the short-term. However, this may be challenging to accomplish and raises issues of sustainability.

Group Clinical Supervision for midwives and burnout: a cluster randomized controlled trial.

BACKGROUND: There are major shortfalls in the midwifery workforce which has been exacerbated by the COVID 19 pandemic. Midwives have high levels of burnout and many, often early career midwives, are planning to leave the profession. There are reports of a poor workplace culture in maternity units, including bullying. Support is essential for the welfare of the workforce to be able to cope with the demands of their jobs. Supportive strategies, such as Clinical Supervision, a recognised approach in healthcare, enable reflection in a facilitated, structured way, and can enhance professional standards. The purpose of this research is to study burnout levels in midwives, those exiting their workplace and perceptions of workplace culture in relation to access to, and attendance of, monthly Clinical Supervision. METHODS: This study will be a cluster randomised controlled trial of maternity sites within Sydney and the surrounding districts. Twelve sites will be recruited and half will receive monthly Clinical Supervision for up to two years. Midwives from all sites will be requested to complete 6-monthly surveys comprising validated measurement tools: the Copenhagen Burnout Inventory (CBI), the Australian Midwifery Workplace Culture (AMWoC) tool and the Clinical Supervision Evaluation Questionnaire (CSEQ) (the latter for intervention sites only). Primary outcomes are the levels of burnout in midwives (using the CBI). Secondary outcomes will be the quality of the intervention (using the CSEQ), perceptions of workplace culture (using the AMWoC tool) and midwives' intention to stay in their role/profession, as well as sick leave rates and numbers of exiting staff. We will also determine the dose effect - ie the impact in relation to how many Clinical Supervision sessions the midwives have attended, as well as other supportive workplace strategies such as mentoring/coaching on outcomes. DISCUSSION: Through attending monthly Clinical Supervision we hypothesise that midwives will report less burnout and more positive perceptions of workplace culture than those in the control sites. The potential implications of which are a productive workforce giving high quality care with the flow-on effect of having physically and psychologically well women and their babies. TRIAL REGISTRATION: The ACTRN Registration number is ACTRN12621000545864p , dated 10/05/2021,.