Nurses and midwives experiences of clinical supervision in practice: a scoping review protocol

Introduction

Clinical supervision is a formal process of professional support that aids nurses and midwives to develop professionally and learn from experience through structured reflection on their practice. Reflection on experiences from clinical practice is the foundation of clinical supervision, allowing professionals to review how they work, develop a greater depth of self-awareness in their clinical practice and identify areas that require improvement for professional development.1 2 Furthermore, structured clinical supervision provides nurses and midwives the opportunity to reflect on their practice and learn from their experiences in a safe and supportive environment.1 3 4

The adoption of clinical supervision as a support for nursing and midwifery practice has magnified in recent years due to heightening awareness that this is a valuable support mechanism that has the potential to positively influence professional practice and advance professional development.5–7 The merits of clinical supervision for healthcare professionals have been widely reported,5–9 beneficial outcomes include greater self-awareness, professional self-confidence and enhanced awareness of own competence,6 clinical supervision has also been reported to reduce work-related psychological burden and ultimately lead to greater fulfilment in professional roles.7 9 The former is particularly relevant in recent times as the worldwide crisis resulting from COVID-19 pandemic has highlighted the emotional impact of nursing and midwifery practice and the need for professional supports.

Progressively, nursing and midwifery regulatory bodies and health service organisations globally are recommending clinical supervision for all nursing and midwifery professionals10–16 and enquiries into cases of failures in practice resulting in detrimental outcomes for service users have specifically highlighted the need for clinical supervision to be made available to enhance professional support.17 18 Yet despite this, access to this aid remains inequitable as the availability of clinical supervision in nursing and midwifery settings continues to vary greatly between disciplines and services. Evidence suggests that this may be a result of inconsistency in how it is practised leading to misinterpretation of how this support functions, mixed messages dilute the beneficial aspects of this support and potentially lead to suspicion that it is a form of managerial surveillance rather than a support mechanism.4 9 Although existing research has explored a variety of aspects of clinical supervision it has also been suggested a paucity of readily available and accessible evidence may impact negatively on its acceptability and perceived value in practice.8 9 Therefore, it is important to establish what evidence exists and to identify the gaps in knowledge to direct future research.

Several models of clinical supervision are used in practice settings with no universal consensus on what form it should take;17 18 this inconsistency creates obstacles for measuring its effectiveness and potentially impacts on how it is actualised in clinical practice due to reduced transparency in what it entails and how it should be implemented.8 9 The format of clinical supervision can vary from one-to-one supervision to peer group supervision, each individual format has its own benefits and challenges and it is recognised that no one ideal form of clinical supervision exists3 4 meaning those undertaking clinical supervision need to really understand the practice to enable them recognise the system that will work for best for their own service.4 Identification of current evidence to underpin how this support is executed in practice is of utmost importance and ongoing research will need to address gaps identified.

Although numerous individual studies have been undertaken that explore professionals’ experiences of this support in practice, there is, currently, little in the way of review evidence in this field. A small number of reviews exist but these are not wholly specific to the experiences of nursing and midwifery professions participating in clinical supervision. A previous rapid review that focused on barriers and enablers of clinical supervision in practice9 highlighted important facilitating factors that included the accommodation of regular protected time, a culture of acceptance of clinical supervision and value for the process. This review also highlighted barriers to the implementation of clinical supervision including time constraints, poor availability of a physical space to undertake clinical supervision in and poor confidence in professional relationships.9 This was supported by Masamha et al
19 who reported mistrust, lack of time and training as barriers to clinical supervision. Cutcliffe et al
8 conducted a systematic review of clinical supervision evaluation studies in nursing in a bid to uncover empirical data regarding its effectiveness and established that there is a growing body of evidence to support clinical supervision but also highlighted that high-quality training in this practice is required to ensure clinical supervision is facilitated effectively. The studies included in this systematic review represented the findings from studies across many different professions and included both undergraduate and post graduate nurses. Findings from these reviews highlighted valuable data and may be transferable to nursing and midwifery, however, it is recognised that each profession is likely to have their own individual challenges and needs.9 Much of the data included these reviews was heterogeneous in nature encompassing a broad set of health and social care professionals whose frame of reference, role and professional values vary from that of nursing and midwifery.

The objectives of these systematic reviews are distinct from those of this scoping review, the purpose of this review is to identify what research has been done that focuses on how nurses and midwives experience clinical supervision, including the methodologies used, and to identify how this practice is defined in the literature. This will allow the authors to identify forms of clinical supervision that have an evidence base regarding how these are experienced by nurses and midwives and identify knowledge gaps. It is important to identify the availability of this evidence in relation to clinical supervision as those who have experienced this in the practice environment are best placed to report on it and potentially identify areas that require further exploration. A scoping review methodological approach will be used as it is particularly useful for identifying what available research exists to highlight current knowledge and bring attention to those areas that warrant further exploration.

A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis was conducted and no other current or in progress scoping reviews or systematic reviews were identified. To our knowledge, there is no scoping review that has sought to examine what research exists on nurses’ and midwives’ experiences of clinical supervision internationally in practice. For these reasons, this scoping review is timely as it will allow for a comprehensive picture of the evidence in the nursing and midwifery population and provide insight into what is already known about how clinical supervision is undertaken within a practice to help inform future research opportunities.

Methods

The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews20 between November 2022 and March 2024.

Patient and public involvement

None.

Search strategy

The search strategy, consisting of three stages, was devised in association with a librarian who has expert knowledge of search strategies. An initial search of the CINAHL Database was performed to establish potentially relevant free-text and index terms. Keywords were identified through consultation with the librarian and other authors, and additional keywords were ascertained by reviewing texts in the scoping phase of the search. Based on these terms, a complete search strategy of the CINAHL Database was prepared and validated with the support of a health sciences research librarian using the Peer Review of Electronic Search Strategies checklist to enhance the quality and comprehensiveness of the search.21 Online supplemental appendix 1 contains the CINAHL Database complete search strategy.

Supplemental material

The keywords and index terms will be combined and searches will be conducted in CINAHL Complete (EBSCOhost), MEDLINE (Ovid), PsycINFO (EBSCO), Embase (Elsevier) and the Cochrane Library. These databases were selected because of their relevance to the subject area and to ensure an extensive range of literature is searched. Each database will have an adapted search strategy aligned with its unique requirements, using both relevant index and free-text terms. The reference lists of the included studies will also be examined to identify any additional relevant studies. It has been acknowledged that scoping review searches may be quite iterative and potentially require adjustment as reviewers become more familiar with the evidence base.20 With this in mind, any adaptions will be documented and reported in the final manuscript to ensure complete transparency of the entire search strategy.

To access the maximum range of available literature and minimise publication bias, a search for grey or unpublished literature will be conducted on ProQuest and Google Scholar (reviewing the first 50 sources returned). An appendix of websites accessed will be included in the final manuscript.

Language restrictions will not be applied during the initial screening of articles. Google Translate will be used to translate the titles and abstracts of non-English articles. If an article is identified as meeting the inclusion criteria, where possible, a translation of the full article will be conducted.

Study selection

Following database searches, the collated results will be uploaded into EndNote V.X9 (Clarivate Analytics, Pennsylvania, USA) and duplicates removed. Two independent reviewers will carry out an initial screening of titles and abstracts using RAYYAN. The scoping review inclusion and exclusion criteria will be used to identify potentially relevant studies. Studies that meet the inclusion criteria will be retrieved in full. All potentially relevant full-text articles will be further screened for suitability for inclusion in the scoping review independently by two reviewers. Any conflicts that arise between the reviewers at each stage of the selection process will be resolved through discussion or with a third reviewer. Full-text studies that fail to meet the inclusion criteria will be excluded and the reasons for exclusion will be included in an appendix of the review. In the event that an article cannot be retrieved in full or clarification is required, the review team will contact the corresponding author. The results of the search and study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.20

Data extraction

Data will be extracted using the extraction tool developed by the reviewers, this tool was adapted from the tool recommended in the JBI Manual for Evidence Synthesis20 to ensure all information relevant to the review is captured. The data abstraction form will be piloted on a randomly selected sample of 10% of the relevant articles and modified as required based on feedback from the team. Full data abstraction will begin once broad consensus among the team had been achieved (ie, per cent agreement >90%). This reflexivity is necessary to ensure an iterative process as data collection tools may require adjustment as the reviewers become familiar with the body of existing evidence.20 Any modifications to the instrument will be detailed in the full scoping review.

Data analysis and presentation

Data extracted from the relevant body of evidence will be presented in a narrative summary and in tables, according to the categories listed in the extraction tool. Descriptive analysis will involve numerical calculations of frequency in order to display the breadth, character and distribution of studies included in the scoping review. The review team will provide a descriptive analysis of the available evidence focusing on geographical locations, type of research methods, design, data analysis, the demographic characteristics of the sample and the components of the supports identified. Data will be categorised and a descriptive analysis presented in tables. The PRISMA-Protocols Extension for Scoping Reviews checklist will be used to guide the review to ensure methodological rigour and enhance the reporting of the results.22 In line with JBI methodology, the review team will not assess or report on the quality of the evidence20 or synthesise the findings of this scoping review.20

Ethics and dissemination

This review does not require ethical approval. Our dissemination strategy includes peer-reviewed publication, presentation and conferences and sharing through stakeholder networks.

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