Which Clinical Supervision in Nursing Strategies Nurses Wish to be Implemented in Their Health Contexts?: Construction and Validation of an Questionnaire

Purpose: This research aims to improve the quality of care through the identification of clinical supervision in nursing strategies that nurses wish to be more implemented in the supervisory processes in use in the different contexts of health. With this study we intended to achieve the following objectives: build and validate an instrument to assess the frequency in which nurses wish the clinical supervision in nursing strategies were implemented; identify the clinical supervision in nursing strategies nurses wish that were more often implemented in health services and identify the clinical supervision in nursing strategies nurses wish that were never implemented in health services.

Methods: This research is part of a quantitative paradigm and it is a comparative descriptive, exploratory and cross study. The non-probabilistic sample consists in 273 nurses of different wards and institutions in Portugal. Data were collected through the application of the Questionnaire of Frequency Assessment of Clinical Supervision in Nursing Strategies, from may to september of 2012, and the analysis was performed using descriptive and inferential statistics. During the development of this research, all ethical issues were taken into consideration.

Results: Nurses working in the health context report that the clinical supervision in nursing strategy they wish to be more implemented is observation (48,0%; n=131) and the reflective report is the strategy they wish to be less (4,8%; n=13). Nurses also said they wish the strategy support was more implemented in their health context (38,5%; n=105). The clinical supervision in nursing strategy that nurses more wish never to be implemented is the distance supervision by skype® (38,5%; n=105). On the contrary, feedback is the strategy that nurses wish less to never be implemented (1,1%; n= 3). In the hospital setting, observation is also the strategy that nurses wish to use more (46,3%; n=81) and the reflective report the strategy they wish to use less (4,6%; n=8). In this context, nurses wish the supervisory group sessions strategy was less implemented (12,0%; n=21) than individual supervision sessions (17,7%; n= 31). In the primary health care setting, observation is still the strategy nurses wish to be more implemented (51,5%; n=50) and the supervisory group sessions the strategy nurses wish to be less implemented (4,1%; n=4). If we compare the results obtained in the hospital setting with the primary health care setting, in one hand we can conclude that nurses from the primary health care setting wish feedback, reflective report and the three supervision at distance strategies were more implemented. On the other hand, nurses from the hospital setting wish case analysis with the supervisee, supervisory group sessions and case analysis in group strategies were more implemented. There are statistically significant differences (p<0,05) between primary health care and hospital nurses' desire to implement reflective report (U=7299,0; p=0,044), supervision at distance by phone (U=6957,0; p=0,012) and supervision at distance by email (U=6885,0; p=0,008) strategies: nurses from the primary health care want to use more those clinical supervision in nursing strategies than nurses who work at the hospital setting. The Cronbach alpha coefficient was calculated to assess the internal consistency of the Questionnaire of Frequency Assessment of Clinical Supervision in Nursing Strategies. Once all clinical supervision in nursing strategies obtained a Cronbach alpha value greater than 0.90, we may say that there is a good internal consistency of the instrument.

Conclusion: As conclusion of the study we highlight that the clinical supervision in nursing strategies that nurses wish to be more frequently implemented in health services are observation, demonstration and support. We may also conclude that there are statistically significant differences (p<0,05) in reflective report, supervision at distance by phone and supervision at distance by email strategies: nurses from the primary health care want to use more those clinical supervision in nursing strategies than nurses who work at the hospital setting. The Questionnaire of Frequency Assessment of Clinical Supervision in Nursing Strategies has reliability and content validity, therefore it can be used in the context of Mentorship, Preceptorship or Clinical Supervision in Nursing.