511 – Develop Professional Supervision Practice in Health and Social Care or Children and Young People’s Settings

KNOWLEDGE

1.2 Outline the theories and models of professional supervision

Supervision in health and social care settings may occur may occur at individual or group levels. Regardless of what level it occurs in, there are several supervision models that supervisors may utilize, which are based on underlying theories of the practice. The various models can be grouped into three main categories, namely, developmental models, psychotherapy-based models and integrative models (Bennett & Deal, 2009). Developmental models are based on the theory of professional development and are tailored to enhance professional development of health and social care workers. There are three main development models applicable in health and social care settings, namely, integrative developmental model, expanded developmental model and supervision based on attachment theory. Integrative developmental model was developed by Stoltenberg et al (1998) and it is based on three key levels of supervisee’s development: entry (Novice), intermediate and advanced levels. According to Stoltenberg et al Delworth (1998), this model works well with recently recruited graduates. The expanded development model was established in 1992 by Skovholdt and Ronnestad (as cited in Bennett & Deal, 2009) and it focuses on eight stages of professional development, namely, transition to professional training, competence, conditional autonomy, imitation of experts, integration, exploration, integrity and individuation.

Psychotherapy-based models and based on psychotherapy theory and largely focuses on staff-supervisor and client-staff relationships and interactions (Haynes et al, 2003). These models include psychodynamic model, person-centred model, cognitive-behavioral model, family therapy model and feminist model. Psychodynamic model focuses primarily on the interactions between clients and staff. During supervision, supervisors focus on concepts such as parallel processing and transference (Haynes et al, 2003). Person-centred model focuses on the supervisor-supervisee interactions. In this case, the supervisee is not perceived as being less of an expert than the supervisor. The main aim of this kind of supervision is to enhance a friendly, warm working environment where supervisees and supervisors engage in a collaborative environment (Haynes et al, 2003). Cognitive-behavioural model focuses on interactions among staff, clients and supervisors. Supervisors join staff in serving clients in order to learn how their cognitions are affecting their relationships and interactions with clients. Where necessary, supervisors work to change cognitions in order to improve skills and outcomes with clients (Haynes et al, 2003). The family therapy model is usually applied in settings where health and social workers work with families. A supervisor seeks to understand a worker’s family history and learned behaviour in order to understand how this affects his/her outcomes with clients. Finally, the feminist model focuses on relationship between supervisors and clients. It is meant to recognize power imbalance between supervisor and staff, to empower staff and to determine ways of enhancing supervisee’s abilities.

Integrative models are developed using a variety theories using two alternative approaches, namely, technical eclecticism or theoretical integration. Technical eclecticism approach involves using ideas and theories developed by different schools of thoughts to create a model (Haynes et al, 2003). On the other hand, theoretical integration approach aims at fusing two or more theories t come up with a more comprehensive theory and then utilize it in creating a model. The most popular integration models include discrimination model, solution-oriented model and systems approach to supervision. Discrimination model is tailored to enhance the training need of each worker based on their personalization skills, conceptualization skills and intervention skills (Haynes et al, 2003). Solution-oriented model incorporates solution-based techniques and aims at empowering workers to come up with solutions to immediate problems and implement them. It is based on family and narrative therapy. Lastly, systems approach to supervision is a model meant to be utilized by supervisors where supervision does not subscribe t any particular model. This model provides various dimensions for the basis of supervision, specific goals of supervision and three stages of supervision in order to guide supervision practice. Haynes et al (2003) argues that supervisors may develop and apply their own models where supervision does not fit into the pre-set models. As well, they may use a combination of the available models where necessary.

1.3 Explain how the requirements of legislation, codes of practice and agreed ways of working influence professional supervision

There are numerous legal and professional standards that guide professional supervision practice in organizations. They influence professional supervision practice in health and social care settings in various ways. To start with, professional standards require supervisors to have adequate knowledge, skills and experience to carry out their roles (Great Britain Law Commission, 2012). Secondly, legal and professional guidelines ensure that supervisors meet management (accountability and competence) function (Great Britain Law Commission, 2012). Supervisors in health and social care settings meet this requirement through understanding and adhering to established care policies and procedures. Supervisors adhering to these principles and policies set well defined priorities and manage supervisee’s workload effectively. They are also effective in measuring performance of each supervisee. As well, allocate work effectively, in accordance to supervisee’s skills and experience (Great Britain Law Commission, 2012).

Further, the established legal and professional standards guiding care practice steers supervision to meet professional development function within organizations (Great Britain Law Commission, 2012). Supervisors addresses this by enabling workers to meet training and post-qualification requirements, enabling them to develop professional competence, enabling them to relate theory to practice, assessing training and development needs, helping workers to solve emerging problems and to initiate fresh ways of working as job needs change and through facilitating development of knowledge and skills among staff. In addition, professional supervisors help workers to reflect on their work, they give feedback on performance and help supervisees to integrate knowledge and skills gained in their work.

According to Great Britain Law Commission (2012), established legal and professional standards guiding care practice steers supervisors to meet support function. They meet this function through enabling workers to cope with stress, giving them advice on how to cope with emotional issues, creating a conducive working climate where workers are able to examine their practice, enabling workers to examine the impact of their work on themsleves, both professionally and personally and by monitoring functions of workers, especially with regard to relationships, team dynamics and effects of stress. According to Great Britain Law Commission (2012), professional standards guiding care practice push supervisors to meet engagement function in organizations. This is achieved through effective communication with staff about organizational goals, changes and initiatives, giving policy clarification, representing the needs of staff to management, discussing with workers and reporting to management on how organizational practices are perceived, managing conflict between workers and between workers and clients and briefing management about deficits in resources. Professional standards also influence supervisors to commit to diversity in all aspects of their work. They are required to give same quality of service to all people, irrespective of age, gender, language, nationality, ethnicity, religion, sexual orientation or disability. These standards push supervisors to ensure that plans, assessments and intervention address the implications of the aforementioned issues. According to Great Britain Law Commission (2012), supervisors are required to ensure that potential vulnerabilities of specific groups of people (including children, aged and disabled) are identified and countered. They are also required to ensure that discrimination of specific groups of people is acknowledged and countered by service provision. Generally, professional supervisors always reflect legislation and professional and ethical standards in managing employees. Established laws and standards give directions to supervisors on how carry out their duties and provides limits on how to carry out these duties in order to prevent deviation.

1.4 Explain how findings from research, critical reviews and inquiries can be used within professional supervision

The application of findings from research, critical reviews and enquiries in professional supervision within a health and social care organization starts with identification of the relevance of these findings in improving care practices. According to Finkelman and Kenner (2012), this requires identification of issues or problems within an organization which may be investigated through research. A professional supervisor should then consider the potential for improving or solving these issues based on the findings of research, critical reviews or enquiries. It is essential for the supervisor to discuss the implications of the findings of the research, critical reviews and enquiries with colleagues, supervisees and managers. Where possible, the supervisor should participate in the process of carrying out research, critical reviews and enquiries. As Finkelman and Kenner (2012) explain, a supervisor should be fully aware of the contents of a research, enquiry or review, especially where he/she is not involved in the research, review or enquiry processes. As Finkelman and Kenner (2012) explain, professional standards guiding health and social care practice require supervisors to always demonstrate analytical skills in evaluating and analysing research evidence and health information. Thus, a supervisor will need to critically analyse and evaluate these findings in considering their application to practice. As well, the supervisor should examine whether available resources are adequate in facilitating implementation of the findings.

According to Dempsey et al (2010), a supervisor needs to use the best available evidence, expertise and respect the attitudes, beliefs and values of all persons involved in the implementation process as well as those that are going to be affected by the findings. Apart from research findings, relevant literature related to care practice should be consulted. Application of the findings may require a review of procedures, guidelines and policies (Dempsey et al, 2010). The supervisor should also participate in the process of disseminating information regarding the desired changes to supervisees and other persons within a health and social care organization. As well, the supervisor should be involved in identification and dissemination of relevant changes in procedures, guidelines and policies. The implementation team should be selected based on individual experience, education and skills and the context of practice (Dempsey et al, 2010). Any judgements and decisions should be made with consideration of implications. The findings from research, reviews ad enquiries may also be used in quality improvement within an organization. A supervisor should participate in the process of quality improvement while giving consideration to care practice standards, guidelines, policies, outcomes and new developments. The supervisor should also spearhead the process of seeking feedback from all available sources regarding the effects of changes linked to the findings. Where necessary, a supervisor should participate in the process of conducting clinical audit in order to understand the impact of the findings. According to Dempsey et al (2010), it is also essential for a supervisor to maintain records of all information which could be used for further research in the future.

1.5 Explain how professional supervision can protect the:

Individual

Professional supervision provides protection to individual/clients in health and social care settings in various ways. To start with, professional supervision ensures that workers fulfil duty of care as per the requirements set in legal, professional and ethical standards guiding care practice (Bernard and Goodyear, 1992). A professional supervisor recognises his/her responsibility to prevent harm and hence clarifies responsibilities for aspects of care with supervisees. As well, the supervisor ensures that care interventions are performed following accurate and comprehensive assessments. As Bernard and Goodyear (1992) explain, professional supervision recognizes and responds in an appropriate manner to unprofessional or unsafe practice. Precisely, a professional supervisor recognizes behaviour that is detrimental to providing optimal care and intervenes through appropriately actions in specific circumstances (Bernard and Goodyear, 1992). As well, a professional supervisor makes a follow-up to prevent recurrence of unsafe practice. Bernard and Goodyear (1992) explain that professional supervision ensures that fundamental rights of a patient (including confidentiality, autonomy and right to suitable and adequate care) are protected. Generally, professional supervision protects clients from unsafe care practices.

Supervisor

Professional supervision requires a supervisor to apply theoretical and practical knowledge and skills simultaneously while undertaking his/her responsibilities. Practical knowledge and skills gained in the course of supervision enhance professional development of a supervisor (Bernard and Goodyear, 1992). A professional supervisor utilizes available guidelines, standards and evidence to evaluate his/her performance. Professional standards require a supervisor to regularly seek feedback from supervisees and to critically reflect on own practice. Based on available information, a professional supervisor undertakes regular self-evaluation of own practice and actively participates in the performance review process. In turn, this helps to protect the position of an individual as the best suited supervisor. According to Bernard and Goodyear (1992), professional supervision helps to build the image and reputation of a supervisor as a person who is unbiased in dealing with supervisees.

Supervisee

According to Bernard and Goodyear (1992), professional supervision ensures that a supervisee is not put into a position where situations may exceed his/her skills, knowledge and experience. As well a supervisee is protected from very stressful and emotional situations. Professional supervisors work towards building and maintaining supervisee’s morale. As well, professional supervision ensures that supervisees are not put in situations where they have to manage unacceptable risks. As Bernard and Goodyear (1992) indicate, professional practice knowledge and skills and gained through tertiary study. Direct practice, reflection and guidance provided by professional supervision enhance accountability, competence and professional development of supervisees. As such, professional supervision serves as a strong source of information, motivation and growth for new employees, thus protecting and securing the position of new workers. Further, professional supervision protects supervisees by ensuring that their fundamental rights are not compromised or overlooked. As Bernard and Goodyear (1992) explains, professional supervision ensures that personal attitudes or values of a worker and not imposed on another worker.

2.1

(532 – 4.2) Explain the performance management cycle

Performance management plays a significant role in motivating and enhancing overall performance of workers in a health and social care setting. It is a cycle involving five main stages, namely, planning, monitoring, developing, rating and rewarding. Planning involves setting goals and performance expectations for workers in order to achieve organizational objectives. A supervisor involved in the planning process also includes measures that will help to determine whether goals and expectations are being met. According to Daniels (2004), it is essential to involve workers in the planning process in order to understand what needs to be done, how it should be done and why it should be done. Monitoring involves measuring the performances of workers and giving them feedback about their progress. This stage provides an opportunity for a supervisor to check how close workers are in meeting their expectations and organizational goals, to identify areas that require improvement and to resolve arising problems in a timely manner (Zaffron & Steve, 2009).

Developing involves developing performance capacity of workers through methods such as improving work processes, giving assignments to increase level of responsibility or to introduce ne skills and giving training (Zaffron & Steve, 2009). Development efforts help workers to keep up with changes in the workplace and to encourage and strengthen good performance. Rating implies evaluation of performance of workers, both individually and in groups, against standards and elements in worker’s performance plan. Performance outcomes are then summarized and a rating of record is assigned. Rewarding involves giving incentives to workers in recognition for their performance, both individually and as members of groups (Zaffron & Steve, 2009). There are many ways of rewarding workers including showing appreciation for a job well done through the use of words such as “thank you”, agency-specific honours, formal cash incentive and award programs (Zaffron & Steve, 2009).

3.1 Explain factors which can result in a power imbalance in professional supervision

Supervisors in most health and social care organizations exercise some form of authority over their subjects. As Quarto (2002) explains, inappropriate dual or multiple relationships between a supervisor and supervisees may lead to exploitation or cause harm on supervisees. Thus, health and social work supervisors need to maintain proper boundaries in their relationships with workers. Power imbalance may also occur between or among supervisees. There are various factors that can lead to power imbalance in professional supervision, including age, race, gender, ethnicity, region, financial status, professional jealousy and organizational conflicts. A study conducted by Quarto (2002) in a health and social care organization found that older employees tend to delegate their work to new younger employees. The study revealed that in some cases, instructors of students on attachment tended to have sexual relationships with them.

3.2 Explain how to address power imbalance in supervision practice

The most appropriate way for a supervisor to start the process of mediating power imbalance is through understanding the feelings of the parties involved. As Morrison (1993) explains, a supervisor needs to create a platform for discussion of the issue with both parties, but separately. After each of the parties feels heard, it is essential to focus on the future, rather than the past. The supervisor should assure that the party who feels aggrieved that the matter is under control. He/she should be sensitized about the importance of not dwelling on negative feelings. Further, discussion with the aggrieved party should be focused on changing his/her mind and make him/her look at the relationship with the other party in terms of common benefit and common responsibility, rather than power struggle (Queensland Government, 2009). For the other party, it is vital for the supervisor to remind him/her to avoid conflicts of interest that would interfere with impartial judgment or professional discretion. If the power imbalance occurs between a worker and a client, the worker should be made to apologize to the client and be reminded to always make the client’s interests primary and to protect them as much as possible (Queensland Government, 2009). In some cases, a supervisor would be required to terminate relationship between a worker and a client and refer the client to another worker in order to protect his/her interests.

As Queensland Government (2009) explains, a supervisor should address power imbalance among workers by informing them about situations that lead to real or potential conflict of interest and the reasonable steps that need to be taken in order to protect interests of all parties. The supervisor may also warn the workers involved not to take advantage of any professional relationship or exploit others to further their business, personal, political or religious interests. If a worker fails to adhere to these instructions, the supervisor can consider reporting him/her to the management for further action. Management can respond by giving a written warning or threat of demotion or suspension from the job (Kerridge et al, 2005). Where power imbalance occurs between supervisor and workers or clients, the supervisor needs to handle the situation wisely by apologizing and by being submissive to the person who feels aggrieved. In extreme cases, it would be advisable for a supervisor to invite an external party to act as mediator between him/her and the aggrieved party (Kerridge et al, 2005).

5.1 Give examples from your own practice of managing conflict situations within a professional supervision

While working at Victoria Medicaid nursing home as a supervisor, I was involved in managing conflict between two nurses, June and Sue. June was a newly graduated nurse and had eight months part-time work experience in Victoria Medicaid nursing home. She loved her job and had always wanted to work with elderly clients. While working at this nursing home June developed a good rapport with Emily, an eighty year old lady. Despite some short term memory loss, Emily was relatively healthy for her age. June was eventually allocated to Emily’s section as she knew her home as well as her relatives well. While June was on her four days off, Sue, another nurse with 4 years experience in caring for the aged was looking after Emily.

One morning as June was enjoying her days off, Emily complained to Sue that she was feeling a little nauseous, hot and had a headache. Sue gave her some Panadol to relieve the symptoms and told her to rest for the day as she was probably getting a virus. By the afternoon Emily was still feeling unwell and she thought she was getting worse so she reported it to me. I went and informed Sue about it and instructed her to examine her condition thoroughly. After examining her, Sue told Emily that she probably was getting a cold and needed to just to rest. That evening Emily did not have dinner and stayed in bed.

The following morning June returned back from her four days off and examined Emily’s condition. June was surprised to find Emily in a bad condition, yet she had only been given pain killers. After consultation, June realized that Sue had taken records of Emily’s condition and had not reported it to the doctor. Upon seeking clarification for this act, Sue replied to June that Emily had developed a terminal disease called septicaemia and further treatment was futile. This led to a conflict between June and Sue regarding the kind of care that ought to have been given to Emily. At this juncture, had noted the disagreements and decided to intervene. I intervened by reminding both nurses that they needed to be guided by legal, professional and ethical standards guiding care practice. Upon evaluating the situation, Sue realized that though she thought she had done the right thing, she had violated ethical principles of nursing including beneficence, autonomy, advocacy and veracity and legal concepts such as negligence and malpractice. Eventually, both June and Sue reached the same conclusion.

5.2 Describe how you reflect on your own practice in managing conflict situations experienced during professional supervision process

Conflict in health and social care settings often occur between workers and also between workers and patients. Thus, conflict management and resolution is an essential role of supervisors in these settings. As Bolton (2010) explains, conflict management and resolution is a process that involves relational complexity and emotional intensity. Thus, it is essential for supervisors to be able to integrate experiential learning and theory into practice at all stages of intervention. An attempt to make sense of a conflict situation through interdependence of experience, theory and practice is known as reflective practice. Reflective practice in conflict management requires identification of conflict management styles employed by an organization and proposed styles in theories (Bolton, 2010). As a supervisor, I would consider meshing conflict management styles employed by staff or organization to those that are proposed in theory in order to come up with the right style. After determining the most suitable conflict management approach, I would invite individuals involved and agree on the rules of the approach. I would then make that parties involved understand that conflict may be a mutual problem and solution process requires negotiation and discussion. I would actively listen to all parties in order to understand their positions and perceptions (Bolton (2010).

Reflective practice requires a critical reflection of concerns, needs and interests of the parties (Taylor, 2000). During conflict management, I would ask for the viewpoints of the parties, respect their opinions and seek for their cooperation in solving the problem. I would also take time to understand goals and motivations of the parties in order to understand how own actions may affect them. A reflective practice would involve trying to understand the conflict situation in objective terms: its impact on delivery of services to the clients, team work, work performance and decision-making process (Schon, 1983). To effectively address conflict situation, I would identify actual issues clearly and concisely, listen with empathy and look at the conflict from the point of view of the parties. I would also be flexible and encourage clarification of feelings. It is vital to agree on the problems before arriving at a mutually acceptable solution. Sometimes, the parties may perceive a problem differently. In such a situation, I would seek to understand the different perceptions of different parties and engage them in brainstorming in order to come up with suitable solutions. Brainstorming process would be open to all ideas applied in practice as well as those that are proposed in theory. I would also allow all parties to have a fair input in generating solutions. Where necessary, I would apply a technique like win-win negotiation in finding solution that would satisfy all parties. During the process of managing a conflict, I would reflectively and thoughtfully consider my experiences. This would help in identifying my own strengths and weaknesses and to apply experiences in improving conflict my management skills through the reflective process (Taylor, 2000). Finally, I would apply my experience in challenging existing feelings, thoughts and conflict resolution strategies and in developing fresh outlook to practice situations.

6.2 Describe how you adapt approaches to your own professional supervision practice in light of feedback from supervisees and others

Supervisors need to respond to feedback by adapting various approaches to own supervision practice. As a supervisor, would start by determining the agreed priorities for resolving the needs of workers, as expressed in the feedback (Swearingen, 2011). I would incorporate relevant information derived from the feedback in developing a plan for care. Further, I would determine the priorities for care based on feedback information and current knowledge and research on health and social care. After determining priorities for care, I would come up with short- and long-term goals and specify conditions for achievement. At this point, I would be able to identify goals that are achievable, measurable and congruent with beliefs and values of individuals and groups within an organization (Swearingen, 2011). In addition, I would, determine and use resources needed to achieve these goals. There is also need for developing criteria for evaluating of expected results. Finally, I would document a plan for care which based on an ongoing analysis of feedback information.

References

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