A Program of Nursing Clinical Supervision in Primary Healthcare: Strategies to Implement

Purpose: In Portugal the discussion and research on clinical supervision in nursing has deepened in the last decade, it being understood that this is a formal process of professional support, facilitating the development of nurse’s cognitive, technical, communication, attitudinal and ethical responsibilities and skills through formative, restorative and normative functions, promoting the quality of professional practice.

The interest in promoting quality health care in an integrated perspective that takes into account the simultaneous development of organizations, professionals and practices, has led to deeper reflection about clinical supervision and its adoption in clinical practice. In this sense, in portugal, we have sought to develop programs of clinical supervision, which from our point of view, in our reality, should result from the work of clarification and legal construction, emerging contexts result of the work and involvement of all stakeholders, to they make sense.

The aim of this research is to contribute to the design of a nursing clinical supervision program in the context of primary health care by identifying a set of strategies of clinical supervision to integrate in it.

Methods: We carried out a exploratory study anchored in the qualitative paradigm. Data collection was done using half-structured interviews, with a sample of 16 nurses from a primary health care center, from a Cluster of Health Centers of the north of the country, between may and december of 2012.

We used the audio recording as a resource for the documentation of the data collected, with the permission of the participants in the written informed consent model. After transcription of the recorded data, we proceeded to its analysis, through content analysis according to the principles of the grounded theory method using the program Nvivo10.

About respect for the ethical questions that guided the study, was requested and obtained the favorable opinion of the Ethics Committee for Health of the North Regional Health Authority, and also by Executive Director and Nurse Supervisor at a Cluster of Health Centers of the north of the country.

Results: Nurses who participated in the study understand that clinical supervision program to implement in the primary health center should include strategies for professional guidance including in complex clinical situations; individual supervision sessions to discuss sensitive topics with supervisor, avoiding exposure in the group; group supervision sessions to share opinions, feelings and emotions, the working group as a support member; practices; observation by the supervisor; reflection on clinical practice; demonstration; continuing education; individual and group case analyze, self supervision; record analyze; reflexive report; feedback; emotional support from the supervisor; learning about coping strategies; safety of health care and prevention of error (standards and guidelines); supervision strategies for distance (phone, mobile and skipe).

Conclusion: In Portugal the implementation of clinical supervision programs in health services is an emerging issue. In this sense we understand that the supervision programs to implementing should not be imported from other realities and cultures.
From the existing models, nurses should reflect and work to build models or programs for their own institutions from the work, reflection and involvement of all stakeholders, to they make sense.

Being nursing clinical supervision a process that allows exploring innovative strategies to promote excellence in nursing practice, we understand that this research contributes in this direction by identifying a set of strategies that nurses consider to be included in a program of clinical supervision in the context of care primary health.