This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice.
Transcultural health care practice: Transcultural clinical supervision in health care practice
Authors: Zenobia Nadirshaw, Bren Torry
As part of the series of 'Educational Materials in Health Care Practice, published by the Department of Health, this particular module seeks to examine transcultural work-based professional relationships; between managers and staff, staff and mentors, and between supervisors and students whom share working partnerships and practices. There has been a recent growth in information that aims to promote knowledge and awareness of transcultural health care practice, particularly with reference to institutional responsibilities; this module aims to 'balance' the transcultural perspective - by examining transcultural supervisory relationships between staff and students working within multi-cultural environments. Other modules examine issues of direct patient care, and line managerial perspectives, organisational structures and institutional responsibilities; when studying the content of this module it is important to draw upon knowledge from these other modules, particularly:
- the politics of diversity by Charles Husband
- transcultural Communication and Health Care Practice by Charles Husband and Edwin Hoffman
- race equality management by Karen Chouhan and Dave Weaver
- multi-disciplinary / Multi-agency Partnerships Across Cultures: A Health Perspective, by Udy Archibong et al
- the Practice Core, by Sue Dyson et al.
Before we proceed further, it would be worth clarifying the different terminology used in clinical supervision, and referred to throughout this module.
An activity that brings skilled supervisors and practitioners together in order to reflect upon their practice. "Supervision aims to identify solutions to problems, improve practice and increase understanding of professional issues" UKCC (1996). There are various models or approaches to clinical supervision; one-to-one supervision, group supervision, peer group supervision. The choice of approach will depend upon a number of factors, including personal choice, access to supervision, length of experience, qualifications, availability of supervisory groups, etc.
A skilled professional who assists practitioners in the development of their skills, knowledge and professional values. A supervisor, in this instance, is a qualified practitioner who has sufficient experience to deploy advice in a supervisory situation. Supervisors may be line managers, or colleagues, who are in a position to counsel staff on practice guidelines and applied policy.
A practitioner who receives professional advice, support and guidance from a supervisor. The UKCC (1996) suggests that clinical supervision will enable the supervisee to develop greater knowledge and a deeper understanding of accountability. Of course, for those practitioners who are very experienced in their field of work, a supervisor may be used more as a source of support for reflection on practice.
Transcultural clinical supervision
Within any good working relationship the effective process of communication and interaction is an essential ingredient. In a clinical supervision relationship, whether it is between two individuals or a group of people, communication and interaction provides the essential framework for the professional relationship to develop. It helps build up trust and rapport, and it provides an articulate process that is empowering, supportive and, when necessary, directive. One of the principle barriers within a clinical supervisory relationship is the presence of 'professional power'. Power inequalities arise within supervisor and supervisee relationships, and between majority ethnic groups and minority ethnic groups. Transcultural clinical supervision is concerned with the process of supervision between practitioners who have different cultural and ethnic backgrounds.
Clinical supervision UKCC regulations
The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1996) produced a position statement on clinical supervision for nurses and health visitors; these principles have since been adopted by their successor, The Nursing and Midwifery Council (2000). The six key statements include:
- "clinical supervision supports practice, enabling practitioners to maintain and promote standards of care.
- clinical supervision is a practice-focused professional relationship involving a practitioner reflecting on practice guided by a skilled supervisor.
- the process of clinical supervision should be developed by practitioners and managers according to local circumstances. Ground rules should be agreed so that practitioners and supervisors approach clinical supervision openly, confidently and are aware of what is involved.
- every practitioner should have access to clinical supervision. Each supervisor should supervise a realistic number of practitioners.
- preparation for supervisors can be effected using 'in house' or external education programmes. The principles and relevance of clinical supervision should be included in pre- and post-registration education programmes.
- evaluation of clinical supervision is needed to assess how it influences care, practice standards and the service. Evaluation systems should be determined locally."
Although not a statutory requirement for nurses or health visitors, clinical supervision is a statutory function for the supervisor of midwives. As stated in The Midwife's Code of Practice, clinical supervision is considered an integral part of the midwifery supervisor's role. Clinical supervision is not a new phenomenon; many other professionals, including psychologists, counsellors, mental health practitioners and social workers, have already practised and developed systems of supervision, both for staff and clients.
Despite deficient, statutory regulation of clinical supervision it is essential support and stability is available for both supervisor and supervisee; intense working partnerships require mutual trust, respect and security, and these are qualities which are developed during long-term relationships and which are necessary for personal and professional development. This may be difficult to achieve within the clinical support group, where turnover of membership can pose a threat to the functional dynamics of the group.
Aims of the module
There are many different models and approaches to clinical supervision;
- One-to-one supervisor (supervisor-supervisee)
- Group Supervision (Supervisor-Supervisees)
- Peer Group Supervision (Dual Roles: Supervisors/Supervisees).
Clinical Supervision should not be confused with other 'supervisory' activities, such as the appraisal system, or mentoring.
This module intends to familiarise you with:
- one particular model of clinical supervision known as The Supervision Triangle
- the supervisory relationship within a multicultural environment.
The supervisor's toolkit
For a full range of activities and exercises in clinical supervision, it is recommended that you refer to the following text;
- Morrison T (2001) Staff Supervision in Social Care: Making a real difference for staff and service users. Pavilion Publishing Ltd: Southampton
The exercises alone, however, will not promote transcultural competence. It is also essential that you refer to the module by:
- Husband C and Hoffman E Transcultural Communication and Health Care Practice