CLINICAL SUPERVISION IN NURSING PRACTICE:

A COMPARATIVE STUDY IN PORTUGAL AND

THE UNITED KINGDOM
SUPERVISÃO CLÍNICA DAS PRÁTICAS DE ENFERMAGEM: UM ESTUDO COMPARATIVO
EM PORTUGAL E NO REINO UNIDO

Wilson Jorge Correia Pinto de Abreu 1

Carol Elizabeth Marrow 2

ABSTRACT

T his research examines the practice of clinical supervision in nursing in both The United Kingdom and Portugal, one important
pilar of safety care. The study was funded by the British Council under the Treaty of Windsor scheme. Forty five nurses from
both countries completed questionnaires. One focus group interview was held in both countries involving three participants, six
in total (only three volunteered) who had also completed the questionnaire. The quantitative data from the questionnaires were
analysed using the Statistical Package for the Social Sciences and the qualitative data from both the questionnaires and the focus
groups were analysed using Colaizzi’s (1978) framework. The findings suggest that clinical supervision has positive benefits
for professional development of nurses and their clinical practice. Constraints are evident, particularly in The United Kingdom
and these included lack of time, lack of understanding of clinical supervision and lack of commitment.Implications for Nursing
Management: Managers need to support clinical supervision for it is important for quality care and evidence based practice.
Protocols for clinical supervision practice would enable managers to lead and support staff ’s professional development and help
to ensure quality care within the organisation.

Key words: Nursing, Quality of Health care, Professional Practice

RESUMO

P retende-se, com esta pesquisa, analisar a forma como é desenvolvida a supervisão clínica no Reino Unido e em Portugal, um
dos pilares importantes de uma política de segurança nos cuidados de saúde. O estudo foi financiado pelo British Council,
através do Tratado de Windsor. Foram participantes deste estudo 45 enfermeiros, aos quais foi aplicado um questionário.
Recorreu-se ainda a um grupo focal em cada um dos países, envolvendo seis participantes (três por país). Os dados quantitativos
obtidos com os questionários foram tratados com recurso ao Statistical Package for the Social Sciences e os dados qualitativos
provenientes do questionário e do grupo focal foram analisados a partir do modelo de análise de conteúdo de Colaizzi (1978).
Os dados obtidos sugerem que a supervisão clínica possui benefícios para o desenvolvimento profissional e para as práticas
profissionais dos enfermeiros. Mas identificaram-se também constrangimentos, principalmente no Reino Unido – apontaram-se a
falta de tempo, um entendimento deficiente sobre a natureza da supervisão clínica e mesmo falta de interesse. Implicações para
a enfermagem: Os gestores devem apoiar a supervisão clínica, dado que esta se revela importante para a qualidade de cuidados
e para a prática baseada em evidências. Devem ser redigidos protocolos para o desenvolvimento da supervisão clínica, tendo em
vista o desenvolvimento profissional dos enfermeiros e a segurança dos cuidados disponibilizados nas instituições.

Palavras-chave: Enfermagem, Qualidade dos Cuidados de Saúde, Prática Profissional

1
Professor Titular, Doutor em Educação, Coordenador de Cursos de Pós Graduação e de Unidade de Investigação, Escola Superior de Enfermagem do Porto, Portugal.
2
Professora Associada, Leitor (aposentada), Universidade de Cumbria, Doutora em Educação, Coordenadora de Cursos de Pós Graduação e de Investigação, Perita Externa
da Comissão Europeia

16 S A N A R E, Sobral, v.11, n.2.,p. 16-24, jul./dez. - 2012

INTRODUCTION AND BACKGROUND
Quality initiatives within UK and Portugal
This collaborative research project was initiated
and developed through insights into the work of many Within The UK there is strong evidence to illustrate that

professional groups and organisations. These insights organisations that encourage and facilitate a culture of

include ideas and research from both The United Kingdom learning amongst the workforce outperform those that do

and Portugal, developments from the European Commission not 7 . Indeed, the concept of quality is highly recognised

founded Thematic European Nursing Network (TENN), and within government National Health System (NHS) and

a European Commission founded ‘Curriculum Development’ Health and Social Care papers. For example: ‘The Operating

project, resulting in a Master of Science in Advanced Framework for the NHS in England 8 ; ‘High Quality Care for

Nursing Practice (Nurse Practitioner, Leadership and Clinical All’ 9 and ‘Inspiring Leaders’; leadership for quality: Guidance

Supervision). for NHS talent and Leadership Plans 10 .

The focus of this research is on clinical supervision as In Portugal, the recent evolution of the Portuguese health

a quality tool within clinical nursing practice in The United system suggests that improvements have been made in terms

Kingdom and Portugal. The research was funded by the of providing safety and quality care. Since the early 1990s, a

British Council under the ‘Treaty of Windsor’ scheme. The considerable increase in total expenditure on health care has

aims of the research were to: occurred, driven mainly by the growth of public health care

• explore the practice of clinical supervision in nursing spending 11 . Proposals for reform were introduced at the end

• examine nurses’ perception of the concept of the 1990’s’, namely the concept of “local health systems”

• define an integrated and comprehensive clinical and a policy of health organizations quality accreditation.

supervision framework Although there have been problems with expenditure

This paper discusses some of the findings of the study. and budgets, the health care system has been subject to

The sample is small thus not representative generally. many reforms. In 2008, the Portuguese Nurses Order (“Ordem

However, the findings could help to raise awareness of the dos Enfermeiros”) established a “Model of Professional

issues relating to clinical supervision in practice. Development”, based on clinical supervision. Clinical

There is a growing concern that the quality of hospital supervision became an important subject in the curricula of

care needs to be improved and monitored systematically in the post graduate courses in many nursing schools. Moreover,

many European Hospitals. In The United Kingdom, the Office evidences are demonstrating that the quality management

for National Statistics showed that more than 40 people died systems in the hospitals, based on ISO 9001: 2008 only can

and 280 were recorded by doctors as being malnourished be fully operative if include a strong and integrated system

when they died in hospitals. A recent report revealed wide of clinical supervision.

variations in care within The United Kingdom. More recently,

it was discovered a very problematic situation in the Literature Review
Stafford Hospital. The Healthcare Commission, in UK, was
alerted by the apparently high mortality rates in patients As a result of the increasing interest in clinical education

admitted as emergencies. A public inquiry was announced and knowledge, there has been a gradual growth in the use

and the final report (Robert Francis Inquiry report) was of clinical supervision in the health organisations over the

published on February 2013, making 290 recommendations. last few decades. There is also increasing evidence that it

The development of supervision and clinical management is becoming an important quality indicator of organisational

were highly recommended. Quality and patient safety are the performance 4 .

cornerstones of the commitment and mission of hospitals,

communities and caregivers. For years, health professionals
The focus of this
and other caregivers have developed methods and strategies research is on
to deliver the best care they can 1-3 . One of the key factors clinical supervision
relating to quality of care is the education and development
as a quality tool
of the nursing profession 4-5 . Clinical support and education
in its many forms provide students and nurses with the
within clinical
opportunity to learn, integrate and develop competences nursing practice in
within a closely supervised environment. Thus, the model The United Kingdom
of clinical supervision for nurses helps to develop safe and
quality care for clients and the community 6 .
and Portugal.
S A N A R E, Sobral, v.11, n.2.,p. 16-24, jul./dez. - 2012 17
 Many of the research studies illustrate that there are
problems relating to the lack of understanding of the concept; Various characteristics
poor development of clinical supervisors and lack of support
of the clinical
and commitment to the practice of clinical supervision.
Therefore, a comprehensive framework could help to
setting including
explain the concept of clinical supervision and develop location, shift work
strategic clinical supervision procedures which are focused and environmental
on safety, support and improvement of quality of nursing
care.
factors may affect the
Proctor’s seminal work 12 on the three interactive functions outcome of clinical
of clinical supervision namely: Formative; Restorative and supervision.
Normative. Berg & Hansson 13 carried out a study to partly
reveal thirteen nurses’ experiences of group supervision. key impediments to the concept in practice; the relationship
Data were collected using tape-recorded open-ended between supervision, staff development and professional
interviews and questionnaires. The second part of the development is widely reported 17 .
interview partly focused on the nurses’ experiences of the Buus & Gonge18 surveyed 239 psychiatric nurses to
group supervision. investigate how often the nurses participated in clinical
The main findings illustrated that the nurses and supervision and to identify any issues among individuals
indirectly the patients became seen and confirmed as unique and the practice setting in relation to the participation.
persons. This confirming process was perceived as involving The findings suggested that participation varies
development of the nurses’ professional competence and considerably and that many of the nursing staff may not
personal qualities partly through encouragement to reflect have participated in clinical supervision at all. Various
on and narrate their practice. characteristics of the clinical setting including location,
Teasdale, Brocklehurst & Thor 14
also assessed the effects shift work and environmental factors may affect the outcome
of clinical supervision and informal support on qualified of clinical supervision.
nurses. The research design involved an opportunistic sample In Portugal, a significant number of research studies on
of two hundred and eleven qualified nurses from eleven clinical supervision were implemented in recent years. Maia
randomly selected hospital and community NHS Trusts in one & Abreu 19 found in their research, that clinical supervision
region in England. was an integral dimension of the nurses’ culture and working
Quantitative data using the Maslach Burnout Inventory life in the wards. They found that clinical supervision was
(MBI) and the Nursing in Context Questionnaire (NICQ) both a collaborative and a supportive process between two
were obtained. Qualitative data were acquired from written or more nurses to encourage the development of professional
critical incidents. skills, promote quality standards in practice and enhance
Five hundred and twenty two questionnaire packages quality and safety of patient care. Similar issues were
were distributed and two hundred and eleven packages were identified by Varandas 20 . She developed a case study which
completed and returned. The NCIQ found that some of the was carried out in a psychiatric hospital (Portugal). The
supervised nurses felt more supported and more able to cope main goal of the study was to understand the broad and
at work and this appeared more significant with more junior complex learning processes developed in the clinical context
nurses. and the way they shape nursing clinical supervision. In her
Marrow 15
investigated clinical supervision in nursing as research clinical supervision is considered an important tool
a means of developing supervisors, supervisees and clinical to promote the quality of the relationship between nurses
practice. Forty qualified nurses from a variety of clinical and patients. The study systematically conceptualizes
settings were involved in the study. Focus group interviews, the origin of and interplay among the factors influencing
individual interviews, rating scales and reflective statements education and supervision. The participants of the study
were utilized to collect the data. were 18 nurses working in the hospital. The data for the study
The findings illustrated that clinical supervision with were collected by a questionnaire (Clinical supervision In
colleagues in clinical settings encouraged their professional Nursing Inventory - V1) and semi-structured interviews.
development and the process illustrated that by using Heron’s Varandas 20 concluded that nurses had an overall positive
interactional framework 16 – supervisors could analyze and attitude towards clinical supervision. They felt that clinical
polish their supervision skills. supervision offers emotional stability to nurses and a link to
However, time, lack of knowledge and commitment were continuing education.

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 Data collection methods
This small scale
study will therefore A questionnaire and a focus group interview were
help to further our conducted. The questionnaire contained closed questions,

understanding of rating scales and one open question on the amount and quality
of clinical supervision. In both countries the questionnaires
the current state of were given to NHS Trust managers (UK) and to the Director of
clinical supervision in Nursing (Portugal) requesting that they disseminate them to

one Health Care Trust registered nurses who were or had been involved in clinical

within both The UK and supervision either as a supervisor or a supervisee. A total

of 45 nurses completed the questionnaires 23 from Portugal
Portugal. and 22 from the UK. The focus groups (UK and Portugal)
involved a total of 6 nurses (three from each country) who
Such as evidenced in this literature review, there is had completed the questionnaire and who had responsibility
indication of the positive benefits of clinical supervision. for the facilitation of clinical supervision within their
Many of the research participants in these studies have working environment. An open ended question was utilised
identified the payback of clinical supervision for themselves, inviting discussion on the participants’ experience of clinical
their practice, the organization and patient care. Clinical supervision in practice. The intention was to have three
supervision could be perceived as a powerful professional focus groups but because of staffing difficulties there were
relationship where there are sometimes intense interactions problems in getting all participants together at one time.
and feelings. This can result in many ethical considerations,
such as the importance of ground rules, contracts and respect ANALYSIS OF DATA
for persons, which can curb researcherly analysis of what
goes on under the label of clinical supervision. Furthermore, The data presented is based on a total of 45 nurses,
there is little evidence of comparative studies of clinical 51% from Portugal and 48.9% from the UK. The participants
supervision in different countries apart from Cutcliffe & worked in a variety of clinical settings including: Medical
Lowe 21 discussed above. This small scale study will therefore Care, Elderly Care, Oncology and Critical Care. The data is
help to further our understanding of the current state of based on a simple rating of answers.
clinical supervision in one Health Care Trust within both The
UK and Portugal. Quantitative Data from the Questionnaires

THE STUDY Table 1 – Participants by country

Frequencies nº %
Research Design and sample Portugal 23 51.1
UK 23 48.9
The study took place in one Acute Health Care Trust in
Total 45 100,0
the United Kingdom and one General Hospital in Portugal.
Volunteers were requested from registered nurses to form
The majority of the participants appear not to provide
two groups: registered nurses (30) and supervisors, also
clinical supervision to peers, as shown in Table 2. At the
registered nurses (20). The intention was to have within
Portuguese Hospital many novice nurses were employed and
each group 50% of participants from each country. A total
not able to offer clinical supervision to peers. Even in this
of 45 nurses from both Portugal and The UK participated in
reality, the number of participants that provided clinical
the study.
supervision was five times superior in Portugal. Those who
provided clinical supervision were invited to indicate the
Ethical Issues
number of hours they spent in doing so.

The study was approved by Ethics in both countries (it

was classed as professional development). Ground rules
regarding confidential and anonymity were established, as
stated in both of the institutions.

S A N A R E, Sobral, v.11, n.2.,p. 16-24, jul./dez. - 2012 19

 Table 2 – Number of participants that currently provide In both countries, we tried to identify the number of
clinical supervision (UK and Portugal) participants that received clinical supervision. Table 6
Do you currently provide clinical displays this information: 24 (53.3%) demonstrates those
Frequencies supervision?
that received clinical supervision.
Yes No
Portugal 14 9
Table 6 – Participants that receive clinical supervision
UK 4 18
Total 18 27
Do you receive CS?
Total
Table 3 illustrates the number of people that the Yes No
supervisors supervised. It appears that in Portugal the Portugal 21 2 23
supervisors have responsibility for supervising quite large UK 3 19 22
Total 24 21 45
numbers of nurses – which can indeed be stressful.

Table 3 – Number of people that the research participants There are a significant number of nurses in Portugal that
supervise (UK and Portugal) receive clinical supervision (21), in comparison with the
colleagues from UK (3).
Portugal UK Total
Frequencies
nº % nº % nº % Table 7 – Participants views on how they would rate
1 - 5 8 57.1 3 75.0 11 61.1 clinical supervision
6 - 11 6 42.9 1 25.0 7 38.9
Total 14 100.0 4 100 18 100.0 How would you rate the CS?
Total
Fair Good Excellent
Participants that provided clinical supervision were Portugal 2 20 0 22
asked to indicate if they received supervision themselves; UK 1 0 2 3
13 (72,2%) did receive supervision. The supervision Total 3 20 2 25
of supervisors by country is as follows. The contexts are
dramatically different, as we can see in the Table 4:
As we can see above, 20 (80%) of them rated the clinical
Table 4 – Number of supervisors that received supervision supervision as Good, 2 (8% ) as Excellent and 13 (2% ) as
(UK and Portugal) Fair.
In one question, we tried to understand the participants’
Portugal UK Total opinion about the relevance of clinical supervision to their
Frequencies
nº % nº % nº %
professional daily work; 15 (60%) of the participants stated
Yes 13 92.9 0 0 13 72,2
No 1 7.1 4 100.0 5 27,8 that clinical supervision was definitely important to nurses’
Total 14 100.0 4 100.0 18 100.0 work. It was interesting to notice that 2 participants from
Portugal stated that it was not relevant to their work!
Those who provided clinical supervision were invited to
indicate the number of hours they spent in providing clinical Table 8 – Participants’ opinion about the relevance of
supervision. The following Table shows the results of the clinical supervision to the professional daily work (UK and
answer, divided in groups. It is interesting to note that Portugal)
in Portugal 6 nurses were providing 41 or more hours of
supervision per month which is 10 or more hours per week! CS and work effectively as a nurse
No, not yes, yes, Total
really generally definitely
Table 5 – Number of hours that participants spend in
Portugal 2 7 13 22
providing CS (UK and Portugal)
UK 0 1 2 3
Total 2 8 15 25
Hours / Month
Country 41 or Total
1 - 10 11 – 20 21 - 30 In another question (Table 9), we tried to understand
more
Portugal 2 5 1 6 14 the participants’ satisfaction with the clinical supervision
UK 4 0 0 0 4 they receive; 15 (60%) of the participants stated that
Total 6 5 1 6 18

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they are indifferent or mildly satisfied. It is important preserve the psychological integrity of the carer.
to acknowledge that 9 (36%) were quite dissatisfied. The (PORT) Clinical supervision helps nurses, namely those
question asked ‘how satisfied are you with the supervision that are new in the profession, to develop knowledge and
you receive?’ does not delve into what actually they are competencies in nursing domain (e.g. decoding phenomena,
dissatisfied with. However, the findings here suggest that formulate nursing diagnosis, defining consistent
the supervision overall could be improved in both Portugal interventions).
and the UK.
Constraints
Table 9 – Participants’ evaluation of clinical supervision Lack of time
they have
(UK) We did it for 3 years but there were time issues.
Level of satisfaction Portugal UK Total That is the reason it is not done regularly. The benefits of
with clinical clinical supervision are not seen because of the time factor.
supervision nº % nº % nº %
(UK) Clinical supervision needs to be integrated
Most satisfied 1 4.5 0 0 1 2.3
effectively in the nurse’s clinical role; otherwise, it will
Indifferent or mildly
14 63.6 1 33.3 15 33.3
satisfied depend only on the motivation of some professionals…
Quite dissatisfied 7 31.8 2 66.7 9 20.0 (PORT) Time is a problem. Without time it is impossible
Total 22 100.0 3 100.0 25 100.0 to reach the objectives.

Analysis of the qualitative data Process issues

Lack of skills, knowledge and understanding
Thematic analysis of the qualitative data from both
the questionnaires and the focus groups was undertaken (UK) The supervisors often lack knowledge, understanding
using Collaizi’s 22
seven – stage process of analysis. Eights and time
themes emerged which were later consolidated to four, (UK) We started it on Ward X 4 years ago so we have
which were validated by sending the transcripts back to the experience and have also completed a course. Knowing the
participants. theory that underpins it makes it more effective – not just
a chat. You need to be more challenging and have mutual
Data from the Focus group trust.
(PORT) Very few people understand clinical supervision.
The focus groups involved discussion of an open question It is often seen as a chit chat and thus not productive. I
asked so the participants their views on the clinical have tried it a couple of times (being supervised) – but they
supervision that they have experienced either as a supervisor did not understand it.
or supervisee. (PORT) Without clinical supervision, it was impossible to
develop the process of accreditation and developing the use
The five key themes from the 1st focus group of information regarding clinical supervision based on ICNP.
data
Confidentialty
Five key themes were established and included the
following: Benefits; Constraints; Process issues; Staff (UK) Confidentiality is important
Development and Clinical Practice. (PORT) We have to ensure that the supervisee feels safe
but also have to maintain the rights of the clients – so
Benefits ground rules regarding confidentiality are important.
(UK) Some models state that confidentially is a main
(UK) Yes – for my career pathway there are jobs I would point of clinical supervision; we need to take care in this
not have gone for without having participated in CS matter, namely when supervisors are at the same time leaders
(UK) There are issues that you have discussed that have with responsibilities in the unit governance.
been helpful for your managerial and clinical role
(PORT) Clinical supervision, is a quite new concept and Staff Development
process in our hospitals, it has an important role in the
process of promoting safe and quality care, but also to (UK) Supervision has been important for my career

S A N A R E, Sobral, v.11, n.2.,p. 16-24, jul./dez. - 2012 21

pathway, there are jobs I would not have gone for. Ability to get people together regularly in order to
(PORT) It helps both the personal and professional provide quality clinical supervision, as people unlikely to
development. attend unless time owing or payment received (1)
A lot of work was done by myself a couple of years
Clinical Practice ago, changing from 1:1 supervision to group. A model was
adopted (Proctor) and our own framework devised. Lots of
(UK) There has been improvement in practice for a topics for the Clinical supervision sessions were suggested.
clinical support worker. She was given the time and explored Unfortunately, this clashed with the introduction of long
things further. We had a whole session on an issue that the days and loss of shift overlap. Working on minimal staffing
RGN should not do but after clinical supervision she changed levels in a busy environment with no allocated time means
her opinion. running clinical supervision sessions is virtually impossible
(PORT) Clinical supervision helps nurses, namely those (1).
that are new in the profession, to develop knowledge
and competencies in the nursing domain (e.g. decoding Qualitative data from 23 questionnaires
phenomena, formulate nursing diagnosis, defining consistent (Portugal)
interventions).
The biggest difficulty I felt in providing clinical
Qualitative data extracted from the supervision was related to the small number of nurses by
questionnaires shift; I accumulated supervision of nurses, supervision of
students and at the same time the delivery of care (1)
This data answers the only open question in the The major obstacle to do clinical supervision is that we
questionnaire. The number in the brackets is the number of need to develop it while performing the duties related to
people who stated the issue: delivery of care (4)
The number of nurses by shift don’t permits that
What do you think is the biggest single supervisor develop with the supervisee the reflexivity he
obstacle to clinical supervision in your area? want. The problem is the same with the students’ supervision
(1)
Qualitative data from 22 questionnaires (UK) The amount of work and the small number of nurses by
shift in the delivery room (1)
Freeing up time for any kind of continuing professional Lack of time (2)
development. This is not taken seriously in this Trust (1) Lack of orientation (1)
Trying to find someone who can supervise can be difficult Lack of time to support the supervisees (1)
(1) Lack of preparation of supervisors to develop clinical
Clinical supervision used to be approximately 30 hours supervision (2)
per month but now we are being pulled away to other areas Supervisors need to have enough time and to have a clear
of work (1) idea of the objectives defined by the institution related to
Lack of time (11) the clinical supervision process. Adding the responsibility
Lack of staff and inadequate skills mix (10) of develop supervision to developing nursing care to many
No ward manager for some time (1) patients is difficult to conciliate sometimes! We need to
Lack of resources and no structured sessions anymore (1) spend more energy and sometimes this is a factor of stress!
Workload (4) (1)

SUMMARY AND DISCUSSION

In this study, clinical In this study, clinical supervision appears to be more

supervision appears prevalent in general nursing in Portugal than in the UK. This
to be more prevalent could be because of all the recent and current changes that

in general nursing in have taken place in the UK Hospital Trusts. The relevancy
of clinical supervision to the evaluation of the Hospitals in
Portugal than in the UK. Portugal and the introduction of the electronic record based
(in the case of nurses) care plan documentation and explain

22 S A N A R E, Sobral, v.11, n.2.,p. 16-24, jul./dez. - 2012

why hospitals are supporting clinical supervision in nursing, It is sad to note that from the UK questionnaire data, that
even the process to be in its beggining. It is important to clinical supervision used to be in place and appeared to
note that in the last five years, nursing schools included be valued. However, there were numerous concerns about
clinical supervision as a subject extensively in the curricula. the lack of time and resources, poor skills mix and heavy
That said, it has been demonstrated that although clinical workloads. Curiously, the Portuguese nurses point out the
supervision is more prevalent in the Portuguese hospital, the same problems, in general – lack of time, small number of
supervisors have responsibility for supervising more nurses nurses by shift, simultaneity of activities… Also the change
at one time than in the UK, which does indeed question in shift patterns seems to also display discontent regarding
whether the quality of the supervision process is in place. clinical supervision in practice.
Notwithstanding, this study took place in one small
Acute Hospital Trust in the North of England and therefore LIMITATIONS, CURRENT AND FUTURE
cannot be representative of the whole of the UK. In other WORK
Trusts in the UK clinical supervision may indeed take place
and be effective. At the same time, the study carried out in There were some limitations in this study, with respect to
Portugal cannot be representative also of the whole of the the sample size and data analysis. The fact that the sample
country. observed was a sample of convenience, and not a random
Our findings illustrate that the majority of the respondents sample, may have presented a problem of representation.
(53.3%) reported that at some time they had experienced However, the information from this study could help to give
clinical supervision. Data also demonstrates differences an indication of the value of clinical supervision within
between the two groups (Portuguese and English), regarding these particular organisations and indeed other institutions
their experiences and evaluation of clinical supervision. of similar size may identify with some of the issues. Further
These results support the argument that clinical supervision to this, we cannot utilise inferential statistics as it is harder
has been accepted, but on occasions is understood as an to find significant relationships from the data, as statistical
extra responsibility within their daily work and therefore tests normally require a larger sample size.
sometimes perceived negatively. This is concerning, as Although small, this study has illustrated important data
research has shown that the concept can help in supporting for us to develop a clinical supervision strategy for practice.
and developing nurses in practice. This will include a contact and ground rules for clinical
Qualitative data from the UK and Portugal (Focus group supervision practice, recognition of models to structure the
and the questionnaires) illustrates that some of the nurses process and education of both supervisors and supervisees.
in the study have benefitted in some way and perceived Collaborative work on this development is ongoing between
clinical supervision as a supportive mechanism for staff the Portuguese and UK partners.
development, improvement in clinical care and important for We would like to offer our thanks to the British Council
career development. This is supported by the literature 18 . for supporting this study.
Indeed, Abreu 6 and Faugier & Butterworth 23 suggest that
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