NHD Issue 149 Clinical supervision and CPD

SKILLS & LEARNING

Sarah Lumley RD County Durham and Darlington NHS Foundation Trust and Freelance Sarah has a wide range of experiences as a nutrition expert in both acute and community settings. She is keen to share her enthusiasm for food and personal development.

REFERENCES Please visit: https://www. nhdmag.com/ references.html

CLINICAL SUPERVISION AND CONTINUOUS PROFESSIONAL DEVELOPMENT It pays to take time to consider the importance of clinical supervision and CPD, planning its implementation to maximise the success of any dietetic venture. This article looks at the key components of clinical supervision.

Continuing education into adulthood, with an emphasis on lifelong learning, has been an area of interest within healthcare for many years, but the acknowledgement of it grew with founding of the American Dietetic Association (ADA) in 1918.1 Today, continuous professional development (CPD), of which clinical supervision is a form, is still an important aspect of any dietitian’s working life. An effective learning tool, clinical supervision can take many forms to fit each individual person, speciality, or department and can evoke positive change and progress.

Furthermore, medical and pharmaceutical advances mean presenting patients are more complex, with more combinations of comorbidities that need to be prioritised. The difficulty for dietitians comes in ensuring that practice is kept up to date, which can be difficult when faced with the time pressures of workload, or with the individual nature of being a freelancer. Clinical supervision can be a rewarding activity to partake in, for the opportunities it provides in enhancing learning and, ultimately, improving patient care.4

THE IMPORTANCE OF CLINICAL SUPERVISION

The definition of clinical supervision can be traced back to the Department of Health and although the original document is difficult to find, it has been quoted or adapted many times by healthcare authoritative bodies, indicating that clinical supervision is an ‘exchange between practicing professionals’ and often relies on the experience of those individuals and the need for trust between them.5 Within CPD, there is an emphasis on autonomy, which could be interpreted as each individual needing to complete their learning within isolation.2 This is not the case, especially within clinical supervision, which encourages the development of meaningful working relationships between colleagues.2

The work of a dietitian is everchanging, due to new research studies being completed, guidelines being reviewed and advances in medicine and pharmaceuticals.2 Social media advances have also meant that service users are exposed to more nutritional research and advice, with differing levels of evidence behind them. It is important that the dietitian has an understanding of the evidence behind any nutritional claims and is supporting their practice with a solid evidence base. This is a key component within the Health and Care Professions Council (HCPC) guidance for dietitians.3 18

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WHAT EXACTLY DOES CLINICAL SUPERVISION ENTAIL?

SKILLS & LEARNING The ‘exchange’ between these colleagues is quite open to interpretation. There are many activities which could be considered part of clinical supervision, as the BDA highlights.6 Each interpretation of what clinical supervision will look like will depend on those who are being served by the session. Like each department, sessions will be tailored depending on the resources available, the expectations of staff and the evaluation of sessions over time.2 It is important, however, that clinical supervision is worthwhile and fulfilling, from a professional and educational perspective.

Therefore, there are key components which should be included in each type or style of clinical supervision.

KEY COMPONENTS OF CLINICAL SUPERVISION

Trusting relationships Clinical supervision, the discussion of current practice or of service user care, could feel quite personal to the individual whose work is being discussed. It is, therefore, crucial that a trusting, working relationship is built.2 There is a need for support within these working relationships, to allow for open and honest discussion to take place.7 A collaborative approach Clinical supervision is for the benefit of everyone involved, the organisation and the service users.2 In order for those involved to get the most out of it, they should be involved in the development and planning of the sessions, including some leadership on topics being discussed.8 It is also important to acknowledge the learning styles which suit each individual, so the session is effective for all involved.2 Focus Taking time away from direct clinical duties to complete clinical supervision sessions can be difficult, especially if the benefit of clinical supervision is not tangible. Having an action plan to take away from each clinical supervision session ensures that those involved have a focus.2 This could be an individual or team action, in order to develop their understanding, or practice, or service users’ satisfaction, or experience.

WHERE CAN CLINICAL SUPERVISION BE SITUATED?

The BDA list of activities considered suitable as CPD includes many that could be considered clinical supervision.6 There is no one size fits all approach, with ideas ranging from the formal and structured, to more informal and freeform sessions. More formal supervision could include a presentation of a service user’s dietetic care by a colleague or case studies.6 Less formal sessions could include work shadowing and coaching.6 Clinical supervision models can work on a one-to-one basis, or in groups.2 Groups can be of one discipline or several, as clinical supervision and CPD extend to all Allied Health Professionals (AHPs).9 Multidisciplinary team (MDT) working is vital in caring for service users, so there is no reason not to include MDT working within clinical supervision. It could be argued that clinical supervision needs to involve all of those working within a service, in order to allow for true understanding and meaningful development.9 By doing so, learning is a shared commitment and service development can be driven by all professions working alongside one another.4 The BDA idea of clinical supervision stretches as far as visiting other departments and reporting back to your own – suggesting cross working can support dietetic advancement and actively encouraging team working.6 OVERCOMING THE CHALLENGES OF CLINICAL SUPERVISION

When implementing any new aspect into your professional life, there can be a series of barriers to overcome. It is important to see these as challenges, which can be manoeuvred, but which may shape the way you choose to complete your clinical supervision, so it is meaningful for you.

Lack of time A lack of time can often be cited as a challenge for healthcare professionals, when trying to alter practice. When considering developing clinical supervision sessions, planning is key.2 This remains crucial when sustaining clinical supervision sessions too, ensuring time is regularly planned in, as part of your working www.NHDmag.com November 2019 - Issue 149

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SKILLS & LEARNING week or month. Also, inclusion of your employer within your plans will likely benefit you, as they may be able to support your request for clinical supervision, given that the benefits of CPD stretch beyond the individual to the wider team, employer and service users.4 Lone working Much of the literature surrounding clinical supervision can be easily transferred to dietitians working within the public sector, where large teams are often working together.

It can be more difficult if the dietitian is working freelance, or is the sole dietitian within their team. It is important to remember that clinical supervision can cross the boundaries of individual professions.9 Depending on your area of work, there may be more benefit for yourself in working with other AHPs, for instance a sports team dietitian working alongside the same team’s physiotherapist, or medical professional.

Where there is less of a team dynamic, there are the options of online resources for individuals to focus on. Alternatively, social media advancements mean there are groups for different specialisms within dietetics, where mentoring and clinical supervision support is available, including freelance dietetics as a specialism within itself.10 Trust Trust has already been mentioned as a key component of clinical supervision success, but it can be difficult to develop, especially if the supervisor and supervisee(s) are unknown to one another.11 In order to establish a good professional relationship, creation of a contract, whereby each party agrees to and is bound by a set of ground

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rules, can help in the primary stages. This creates a boundary, around which each party can become accustomed to the other and build a deeper trusting relationship as appropriate.11 CONCLUSION

Clinical supervision should be embraced by all dietitians, as a lasting aspect within our professional roles. It can be used to motivate and drive us to improve ourselves and our services for our users, creating a sense of job satisfaction and pride. As our profession develops, so do our clinical supervision needs, highlighting that whilst there are key components to include, we all have different professional barriers to overcome.

Thus, our clinical supervision will take very different forms, to ensure it is effective for us all.

The words of E Neige Todhunter, ADA President 1957-58, still ring true today: “Within dietetics, there is a need to read, think and do”.1 Together we can read the literature, critically think about what is written and the implications for practice and take action, changing our practice together, to improve the services we offer and the experiences of our healthcare users.

More information There are a lot of resources available to support you in starting or developing your own clinical supervision sessions. These include the BDA and other AHP professional bodies, the HCPC, Effective Practitioner and The Interprofessional CPD and Lifelong Learning UK Working Group. There may be existing inhouse training opportunities or resources you can utilise too, so consider speaking with your colleagues, management, or development department, to support you in setting up clinical supervision in your workplace.

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Continuing professional development To view our latest NHD CPD eARTICLE please visit NHDmag.com 20

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