SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
45 Southeastern European Medical Journal, 2019; 3(2)
Original article
Representation of Topics Regarding Clinical Supervision in Nursing in
National and International Journals 1
Ana Budrovac 1, Nada Prlić 2
1 Health Centre Osijek, Croatia
2 Faculty of Dental Medicine and Health Osijek, Croatia
Corresponding author: Ana Budrovac, anabud94@gmail.com
Received: May 29, 2019; revised version accepted: Dec 4, 2019; published: Dec 16, 2019
KEYWORDS: clinical supervision, database, nursing, supervisory
Abstract
Aim: The aim of this paper was to examine the representation of topics of clinical supervision in
nursing in national and international journals.
Methods: A Databases Medline, EBSCO and Hrčak were retrospectively researched. The research
encompassed nursing journals published from 2011 to 2015. MeSH keywords were used as well. The
availability of articles in full text was examined by PubMed Central and by using PERO, a search
engine for electronic resources online, which is an online source of journals with articles available in
full text to the Croatian scientific and academic community. A total of 168 articles and 54 journals
were included in this research.
Results: The topic of clinical supervision in nursing has not been found in any of the papers
published in Croatian journals. There were 168 scientific papers about clinical supervision in nursing
in 54 international journals. In the “Journal of Nursing Management” there was a trend of a decreasing
number of published scientific papers (Cochran–Armitage test p< 0.0001). In the Medline database
there were 43 journals. Most journals were published in the USA, 23 of them. A total of 29 articles are
available in full form. OvidSP enables access to the highest number of articles, 18 (62.1%), while PERO
search engine found no articles in full form.
Conclusion: In national journals in Croatia there are no topics regarding clinical supervision in
nursing, but there are some in international journals.
(Budrovac A, Prlić N. Representation of Topics Regarding Clinical Supervision in Nursing in National
and International Journals. SEEMEDJ 2019; 3(2); 45-55)
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
46 Southeastern European Medical Journal, 2019; 3(2)
Introduction
Definition of the word “supervise” is to watch
somebody or something to make sure that work,
etc is being done properly and that people are
behaving correctly (1). That is why nurses very
often have a negative attitude towards clinical
supervision (CS). Smith highlighted that it is not
about controlling somebody; instead, it is about
empowering staff. Sabrage said it has been
described in literature as “time for me” (2). In
addition to that, Fowler stated that nurses
should sometimes put themselves before others
(3), which gives CS a completely different
meaning.
There have been many attempts to define CS.
According to the Care Quality Commission, “the
purpose of CS is to provide a safe and
confidential environment for staff to reflect on
and discuss their work, personal and
professional response to their work. The focus is
on supporting staff in their personal and
professional development and in reflecting on
their practice” (4).
Furthermore, the Royal College of Nursing
states that the term “clinical supervision” is used
to describe a formal process of professional
support and learning which enables
practitioners to develop knowledge and
competence, assume responsibility for their own
practice and enhance consumer protection and
the safety of care in complex clinical situations.
It is central to the process of learning and to the
expansion of the scope of practice and should
be seen as a means of encouraging self-
assessment and analytic and reflective skills (5).
Bishop and Sweeney described it as ”designated
interaction between two or more practitioners
within a safe and supportive environment, that
enables a continuum of reflective critical
analysis of care, to ensure quality patient
services and the wellbeing of the practitioner”
(6).
Despite these and numerous other definitions,
many authors state that definition of clinical
supervision is still unclear (7,8).
Butterworth et all justify this by explaining that
there are many different definitions, especially
among states because of socio-cultural impact
(9). Fowler explains that “the practice of clinical
supervision will and should vary because the
practice of nursing varies across different
environments and patient groups” (10). Except
those, he describes some more factors, such as
ward culture and organisation, ratio of the
number of employees, employees’ needs and
management (11).
Clinical supervision can be implemented in
different ways. It can be implemented as a one-
to-one relationship or group supervision. The
other consideration is whether supervision is
among peers, in a team or multidisciplinary.
One-to-one is a fairly common model, where a
more experienced nurse supervises a less
experienced one. Experienced specialist nurses
can be involved in “peer supervision”, whereby
staff of similar experience and profession “co-
supervise” each other. However, a specialist
nurse can also receive supervision from
someone with greater experience, but who is not
a nurse. There are three types of CS groups:
peer, team and multidisciplinary groups. In peer
CS groups, all staff members are of similar
qualifications and experience (e.g. nurses,
clinical managers, healthcare assistants, clinical
nurse specialists). Team supervision occurs
within the established hierarchical clinical team.
Multidisciplinary supervision tends to occur
where multidisciplinary staff work closely
together (12).
One of the three most frequently cited models
was reported by Winstanley and White –
Proctor's interactive model, highlighting the
normative (managerial), formative (educative)
and restorative (supportive) functions of
supervision (13). The aim of the normative
component is to support reflection on practise
with an awareness of local policy and codes of
conduct. Formative component focuses on the
development of skills, knowledge, attitudes and
understanding. Restorative component fosters
resilience through nurturing supportive
relationships that offer motivation and
encouragement and that can also be drawn
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
47 Southeastern European Medical Journal, 2019; 3(2)
upon in times of stress (14). That model has
become the most used model (15).
Although the principles of clinical supervision
are simple, its implementation is more difficult. It
requires time, commitment, openness to self-
reflection, admission of areas of weakness and a
wiliness to develop and grow (3). Many authors
describe lack of time as the main barrier to
clinical supervision implementation (16-20).
Fowler states that we must make time for clinical
supervision, it needs to be viewed in the same
way as mandatory training, days off or annual
leave (21).
There are many benefits of CS, some of them
are: improved employee retention, better
motivation and commitment to the organisation,
maintenance of clinical skills and quality
practice, improved communication among
workers, increased job satisfaction, self-critique
of clinical and cultural practice in a safe
environment, development of strategies to
address issues raised as part of critiquing and
reflecting on practice, identification of strengths
in practice, identification of learning
opportunities to enhance further development
of nursing practice, prevention of burnout,
nursing leadership development (22).
The aim of this paper was to examine the
representation of clinical supervision topics in
nursing in national and international journals.
Material and methods
Databases Medline, EBSCO and Hrčak were
retrospectively researched. The research
encompassed nursing journals published from
2011 to 2015. MeSH keywords “Organization and
Administration” and “Nursing, supervisory” were
used for searching the Medline database.
Subheading “Standards” was used to restrict the
heading “Organization and Administration” and
searching was restricted to nursing journals.
Subheadings “Standards”, “Organization and
Administration” and “Statistic & Numerical Data”
were used to restrict the heading “Nursing,
supervisory” (Figure 1).
For searching the EBSCO database, the title
“clinical supervision” and subject term “nursing”
were combined with Boolean operator AND
(Figure 1).
Keyword “supervizija”/ “supervision” was used
for searching the database Hrčak. Results were
restricted to the area of “Biomedicine and
Healthcare” (Figure 1).
Results in all databases were restricted to
nursing journals (Figure 1).
Nursing journals which did not have access to all
or some parts of journal volumes were excluded
from research.
In all included journals, the main focus was on
looking for all published articles and all articles
about clinical supervision in the period from 2011
to 2015.
The availability of articles in full text was
examined by PubMed Central and by using
PERO. A total of 168 articles and 54 journals were
used in this research (Figure 1).
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
48 Southeastern European Medical Journal, 2019; 3(2)
Figure 1. Flow chart
* Use the keyword 'supervision' then continue to search Heading Organization & Administration
† Global Health Action; Global Journal of Health Science; Palliative Medicine; Studies in Health Technology
and Informatics; Health Service Journal; Advances in Health Care Management; Advances in Neonatal Care;
Giornale Italiano di Medicina del Lavoro ed Ergonomia; Journal of the Medical Association of Thailand; Critical and
Resuscitation; Journal of Intellectual and Developmental Disability; International Journal of Evidence-Based Health
Care; Journal of Occupational Rehabilitation
‡ Journal of Intellectual Disabilities and Offending Behaviour; Scandinavian Journal of Caring Sciences;
Research on Social Work Practice
§ Nursing Standard; Australian Nursing & Midwifery Journal; Mental Health Nursing; British Journal of Nursing;
American Journal of Nursing; Insight; Nursing Times; Nursing New Zealand (Wellington); Tar Heel Nurse; RCM
Midwives
ǁ JARNA; Nursing Standard; Mental Health Nursing; Community Practitioner;
Nosileftiki; British Journal of Nursing; Communicating Nursing Research; Practice Nurse; Australian Nursing &
Midwifery Journal
¶ Miller A, Buerhaus PI. The changing nature of ICU charge nurses' decision making: from supervision of care
delivery to unit resource management. Joint Commission Journal on Quality & Patient Safety. 2013;39:38-47.
** Perspectives in Psychiatric Care; Nursing & Health Sciences; Journal of Advanced Nursing; Nurse Education
Today; Nurse Education in Practice; Journal of Psychiatric & Mental Health Nursing; Journal of Clinical Nursing;
Journal of Nursing Management; Issues in Mental Health Nursing; Australian Critical Care; International Journal of
Mental Health Nursing
†† Gonge H, Buus N. Model for investigating the benefits of clinical supervision in psychiatric nursing: A survey
study. International Journal of Mental Health Nursing. 2011;20:102-11.
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
49 Southeastern European Medical Journal, 2019; 3(2)
Cross WM, Moore AG, Sampson T, Kitch C, Ockerby C. Implementing clinical supervision for ICU Outreach Nurses: A case study
of their journey. Australian Critical Care. 2012;25:263-70.
Kenny A, Allenby A. Implementing clinical supervision for Australian rural nurses. Nurse Education in Practice. 2013;13:165-9.
Koivu A, Hyrkas K, Saarinen PI. Who attends clinical supervision? The uptake of clinical supervision by hospital nurses. Journal
of Nursing Management. 2011;19:69-79.
Gonge H, Buus N. Is it possible to strengthen psychiatric nursing staff's clinical supervision? RTC of meta-supervision
intervention. Journal of Advanced Nursing. 2015;71:909-21.
Sharrock J, Javen L, McDonald S. Clinical supervision for transition to advanced practice. Perspectives in Psychiatric Care.
2013;49:118-25.
Carver N, Clibbens N, Ashmore R, Sheldon J. Mental health pre-registration nursing students' experiences of group clinical
supervision: a UK longitudinal qualitative study. Nurse Education in Practice. 2014;14:123-9.
Results
The topic of clinical supervision in nursing has
not been found in any of the papers published in
Croatian journals. There were 168 scientific
papers about clinical supervision in nursing in
international journals. The biggest number of
journals about CS were published in 2011, a total
of 46. The fewest were published in 2014, only
25. The “Journal of Nursing Management”
contained the most scientific papers about CS in
2011, specifically 19 of them. In that journal there
was also a trend of reduced number of
published articles in the period from 2011 to 2015
(Cochran – Armitage test p<0,0001) (Table 1)..
Table 1. Representation of topics regarding clinical supervision in nursing in international journals
Journal
Total number of published articles (proportion of articles dealing with clinical supervision)
2011 2012 2013 2014 2015 P*
BMC Nursing
24 (0) 28 (0) 29 (0) 50 (0) 85 (1) 0.34
Nordic Journal of Nursing Research & Clinical Studies /Vard i Norden
36 (0) 41 (0) 40 (2) 43 (0) 38 (0) 0.97
Perspectives in Psychiatric Care
32 (0) 30 (0) 35 (1) 35 (0) 35 (0) 0.96
Nursing & Health Sciences
76 (1) 71 (1) 75 (1) 73 (0) 71 (1) 0.74
International Journal of Nursing Studies
166 (1) 163 (0) 168 (0) 170 (0) 198 (1) 0.93
Journal of Advanced Nursing
253 (0) 256 (2) 266 (0) 267 (2) 253 (1) 0.53
Nurse Education Today
182 (0) 191 (1) 282 (3) 268 (0) 270 (2) 0.6
Nurse Education in Practice
105 (1) 114 (1) 170 (3) 120 (3) 93 (1) 0.56
Journal of Psychiatric & Mental Health Nursing
136 (0) 111 (1) 122 (1) 113 (2) 96 (0) 0.58
Journal of Clinical Nursing
395 (1) 385 (2) 358 (0) 368 (1) 368 (0) 0.32
CONNECT: The World of Critical Care Nursing
25 (0) 26 (0) 17 (0) 20 (1) 19 (0) 0.41
British Journal of Midwifery
149 (0) 169 (0) 150 (0) 168 (1) 162 (0) 0.49
Journal of Nursing Education Scholarship
28 (0) 26 (1) 36 (0) 18 (0) 20 (0) 0.54
Contemporary Nurse: A Journal for the Australian Nursing Profession
88 (0) 84 (0) 84 (1) 73 (0) 49 (0) 0.86
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
50 Southeastern European Medical Journal, 2019; 3(2)
Table 1a. Representation of topics regarding clinical supervision in nursing in international journals
Journal
Total number of published articles (proportion of articles dealing with clinical supervision)
2011 2012 2013 2014 2015 P*
Journal of Nursing Management
109 (19) 205 (3) 106 (0) 100 (0) 112 (4) <0.0001
Australian Critical Care
102 (0) 80 (1) 79 (0) 97 (0) 90 (0) 0.49
International Journal of Mental Health Nursing
52 (2) 68 (0) 63 (3) 65 (0) 64 (0) 0.16
Journal of Nursing Measurement
14 (0) 17 (0) 34 (0) 43 (1) 46 (0) 0.74
Obzornik Zdravstvene Nege
37 (1) 28 (0) 30 (0) 26 (0) 26 (0) 0.98
Klinisk Sygepleje
29 (0) 31 (1) 34 (0) 28 (0) 29 (0) 0.48
Assistenza Infermieristica e Ricerca:Air
25 (0) 34 (2) 28 (0) 30 (0) 27 (1) 1.00
Practising Midwife
99 (1) 118 (3) 113 (3) 110 (7) 114 (6) 0.05
Nursing Economics
42 (0) 48 (0) 39 (0) 34 (0) 46 (1) 0.16
Health Care Manager
43 (0) 37 (0) 41 (1) 38 (0) 47 (1) 0.35
JOGNN – Journal of Obstetric, Gynecologic, & Neonatal Nursing
100 (0) 100 (0) 92 (2) 89 (0) 98 (1) 0.39
Nursing Management (Harrow)
171 (1) 148 (3) 74 (2) 176 (1) 111 (1) 0.82
Professioni Infermieristiche
23 (0) 27 (0) 26 (0) 27 (0) 28 (1) 0.17
Soins; La Revue de Reference Infirmiere
255 (0) 185 (0) 172 (0) 156 (1) 140 (0) 0.37
CIN: Computers, Informatics, Nursing
132 (0) 106 (0) 104 (0) 97 (1) 99 (0) 0.43
Women & Birth: Journal of the Australian College of Midwives
26 (0) 35 (0) 72 (0) 60 (1) 72 (0) 0.66
The Gerontologist
73 (0) 91 (0) 107 (0) 115 (1) 121 (0) 0.58
Worldviews on Evidence-Based Nursing
26 (2) 25 (0) 19 (1) 48 (1) 46 (0) 0.11
Queensland Nurse
53 (0) 53 (0) 59 (1) 63 (0) 45 (0) 0.99
Nursing Administration Quarterly
43 (3) 46 (0) 57 (2) 55 (0) 60 (1) 0.14
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
51 Southeastern European Medical Journal, 2019; 3(2)
Table 1b. Representation of topics regarding clinical supervision in nursing in international journals
Journal
Total number of published articles (proportion of articles dealing with clinical supervision)
2011 2012 2013 2014 2015 P*
Journal of Nursing Administration
106 (1) 112 (3) 122 (3) 116 (0) 121 (1) 0.38
Nursing Forum
32 (1) 33 (0) 34 (3) 32 (0) 35 (0) 0.45
Canadian Nurse
209 (0) 206 (1) 205 (2) 203 (0) 167 (0) 0.76
Joint Commission Journal on Quality & Patient Safety
69 (0) 65 (0) 70 (1) 71 (0) 72 (0) 0.98
Journal of Nursing Care Quality
45 (0) 51 (0) 45 (2) 48 (0) 53 (0) 0.96
Midwifery
154 (0) 117 (0) 177 (1) 156 (0) 146 (0) 0.98
MCN, American Journal of Maternal Child Nursing
85 (0) 81 (1) 87 (0) 82 (0) 92 (0) 0.47
Krankenpflege – Soins Infirmiers
158 (0) 163 (1) 147 (0) 171 (0) 202 (0) 0.44
Online Journal of Issues in Nursing
28 (1) 26 (1) 24 (0) 22 (0) 24 (0) 0.16
Research in Nursing & Health
40 (0) 52 (1) 47 (0) 45 (0) 43 (0) 0.47
Nursing leadership (Toronto, Ont)
33 (2) 45 (0) 44 (0) 30 (0) 18 (0) 0.05
Issues in Mental Health Nursing
127 (1) 133 (0) 142 (1) 128 (0) 138 (0) 0.30
Public Health Nursing
64 (1) 63 (0) 62 (0) 62 (0) 75 (0) 0.15
Journal of Cardiovascular Nursing
74 (1) 60 (0) 72 (0) 82 (0) 84 (0) 0.14
Journal of Emergency Nursing
137 (1) 159 (0) 154 (0) 150 (0) 140 (0) 0.15
Journal of the American Medical Directors Association
107 (1) 183 (0) 200 (0) 150 (0) 213 (0) 0.10
AAOHN Journal
73 (1) 95 (0) 93 (0) 91 (0) 88 (0) 0.13
International Nursing Review
92 (1) 103 (0) 81 (0) 74 (0) 74 (0) 0.19
Journal of the American Association of Nurse Practitioners
82 (0) 86 (0) 89 (0) 83 (0) 112 (1) 0.19
Mental Health Practice
220 (1) 206 (0) 185 (1) 177 (1) 186 (0) 0.78
Total
5084 (46) 5216 (30) 5261 (41) 5216 (25) 5261 (26) 0.01
* Cochran – Armitage test
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
52 Southeastern European Medical Journal, 2019; 3(2)
Most of the journals in which scientific papers
about CS were published were found in the
Medline database, specifically 43 of them. In the
Hrčak database there were no journals
containing articles about CS in nursing (Table 2).
Table 2. Representation in databases Medline, EBSCO and Hrčak of journals in which articles about
clinical supervision in nursing were published
Database
Number (%)
Total number of journals
Journals in which articles about CS were
published
Medline 1235 (100) 43 (3.5)
EBSCO 15337 (100) 22 (0.1)
Hrčak 437 (100) 0
In total, there were 54 journals in which articles
about CS in nursing were published. Most of the
journals were published in USA, 23 (42,5 %) of
them. Slovenia, France, Switzerland and
Denmark each had only one journal with articles
about CS in nursing published (Table 3).
Table 3. List of countries publishing journals in which articles about CS in nursing were published
Country publishing journal
Number (%) of journals in which articles about CS in
nursing were published
USA 23 (42.5)
Great Britain 19 (35.1)
Australia 4 (7.4)
Canada 2 (3.7)
Italia 2 (3.7)
Slovenia 1 (1.9)
France 1 (1.9)
Switzerland 1 (1.9)
Denmark 1 (1.9)
Total 54 (100)
Most of the articles were published in UK,
specifically 105 (62,5 %) of them.
In 2015, there were 19 articles (73,1 %) (Table 4).
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
53 Southeastern European Medical Journal, 2019; 3(2)
Table 4. List of countries where articles about CS in nursing were published between 2011 and 2015
Country
publishing
journal
Number (%) of articles
Total
N (%)
P*
2011. 2012. 2013. 2014. 2015.
USA 12 (26.1) 7 (23.4) 17 (41.4) 5 (20) 5 (19.2) 46 (27.4) 0.18
UK 31 (67.4) 17 (56.7) 20 (48.8) 18 (72) 19 (73.1) 105 (62.5) 0.19
Australia 0 1 (3.3) 2 (4.9) 1 (4) 0 4 (2.4) 0.51
Canada 2 (4.3) 1 (3.3) 2 (4.9) 0 0 5 (2.9) 0.67
Italy 0 2 (6.7) 0 0 2 (7.7) 4 (2.4) 0.09
Slovenia 1 (2.2) 0 0 0 0 1 (0.6) 0.62
France 0 0 0 1 (4) 0 1 (0.6) 0.19
Switzerland 0 1 (3.3) 0 0 0 1 (0.6) 0.33
Denmark 0 1 (3.3) 0 0 0 1 (0.6) 0.33
Total 46 (100) 30 (100) 41 (100) 25 (100) 26 (100) 168 (100)
In total, 29 articles about CS in nursing are
available in full text to the Croatian Academic
Community through the Academic and
Biomedical Consortium. OvidSP provides access
to the largest number of articles, 18 (62,1 %) of
them, while PERO alone does not provide
access to any article in full form (Table 5).
Table 5. Available articles about CS in nursing in full text
Browser (interface) Number (%) of articles in full text
Only PERO 0
Only PubMed Central 1 (3.5)
Only OvidSP 18 (62.1)
EBSCOhost, PERO 7 (24.1)
OvidSP, PERO 3 (10.3)
Total 29 (100)
SEEMEDJ 2019, VOL 3, NO. 2 Clinical supervision in nursing in journals
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Discussion
After searching for articles about CS, it can be
concluded that many articles give a review of
that topic, especially of a specific topic within CS,
for example CS evaluation (9), the effectiveness
of group CS in reducing stress (23), organization
of CS in nursing (24), empirical research on CS in
psychiatric care (7), concept and definition of CS
(25), administrative CS (26).
In order to find papers about CS, most of the
authors searched databases such as Medline
(PubMed) and CINAHL(7, 27, 15, 23, 26). Some of
them searched PsycINFO (7, 15), MEDIC, LINDA
(26), Pre-CINAHL, and Academic Elite (27) as
well.
It can be seen that authors who searched the
EBSCO database also searched databases
CINAHL and PsycINFO. For the purposes of this
research, apart from the CINAHL database,
databases Health Source-Consumer Edition and
Health Source: Nursing/Academic Edition were
searched. Database PsycINFO was not
searched.
The most commonly used keyword was “clinical
supervision” (27, 15, 23). In one case, “clinical
supervision” was combined with the keyword
“nurse” (27). Keywords “supervision” and “nursing
supervisory” were used as well (15).
It is interesting that only one author used the
MeSH term “Nursing Supervisory” (15). None of
them used the MeSH term “Organization and
Administration”, which is synonymous with the
term “Supervision” (28).
This research showed that articles about CS
were published in a lot of journals (if we consider
the number of articles). But if we look closer, it is
obvious that more than half of the journals, 29 to
be precise, published only one article in a period
of five years. The rest of the journals did not
publish more than ten articles. The journal
"Practising Midwife” published 20 articles and
the “Journal of Nursing Management” published
26 articles.
Acknowledgement.
I would like to thank Professor Ljiljana Pavičić for
helping me write this paper. The paper was
presented as a master's thesis at the Faculty of
Medicine of J. J. Strossmayer University in Osijek
on September ¬¬11, 2017.
Disclosure
Funding. No specific funding was received for
this study.
Competing interests. None to declare.
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