Ethical dilemmas in clinical supervision 2: need for guidelines

Abstract

In this, the second half of this two-part article, the authors focus on ethical dilemmas in clinical supervision. Referring to the case vignettes included in the first part of this article (Vol 7(15): 920-3), the authors highlight how ethical dilemmas can arise and then provide some discussion on how they might be handled. As a result of the discussion, the authors conclude that there is a clear need for a specific set of guidelines to be produced that would help safeguard best practice within clinical supervision and ensure it remains an opportunity to help and support nurses in reflecting on their dilemmas, difficulties and successes (Cutcliffe and Proctor, 1998a). This would prevent supervision from becoming another form of management monitoring which might inadvertently prevent the resolution of intra- and interpersonal issues affecting the care of clients.

Evaluation of the concept of supervision related to public health nurses in Norway

“…What is going on, according to the papers’ analysis, can be labelled ‘pedagogic’. Concepts used that might be labelled pedagogic are: educative (Cutcliffe et al. 1998a*,b*), learning (Fowler 1996*), help to understand (Jones 1998*), development (Severinsson 1996*, Playle & Mullarkey 1998*), enabling (Porter 1997*), didactic (Severinsson & Borgenhammar 1997*, Severinsson 2001*), facilitating (Todd & Freshwater 1999*), transforming (Williamson & Dodds 1999*), professional growth (Yegdich 1999*).…”

“…When the boundaries are unclear, it is difficult to use the concepts correctly and it is difficult to identify and recognize the behaviour related to the concept. Cutcliffe et al. (1998a*,b*) state that supervision differs from management, while Goorapah (1997)* states that supervision is intended to replace traditional support systems and thus connects the concept of supervision to leadership.…”

“…Todd and Freshwater (1999)* describe the boundaries with psychotherapy as unclear, while Jones (1998)* states that supervision has clear boundaries with psychotherapy. Some authors differ as regards types of supervision, managerial or clinical (Cutcliffe et al. 1998b*, Yegdich 1999*).…”

Education in the workplace

“…Lack of power is an obstacle in this environment of authoritarian hierarchy, where surgical trainees lack in age, experience, longevity in job role and inferior job title compared with other team members. It is clear that supervision by someone who is able to understand both the emotions relating to the incident and the clinical environment in which it took place is extremely valuable. Therefore, the trainee should not be burdened alone with these feelings, and if problems remain hidden, it cannot lead to safe practice, especially when a supervisee's mood and outlook have the potential to affect clinical performance and patient safety.…”

Egalitarian consultation meetings: an alternative to received wisdom about clinical supervision in psychiatric nursing practice

“…Thus, for example, what confidentiality consists in, what form of recording is appropriate, what is useful in CS, can emerge through the process of meetings. CS should be separate from line management as far as possible. In a sophisticated analysis of ethical dilemmas, Cutcliffe et al (1998a, 1998b) advocate careful analysis of cases before automatically informing the management, on the grounds that rigidly reporting all issues is a disabling philosophy within CS. As Consedine (1995) points out, nurses are understandably reluctant to expose and analyse their personal private responses to patients in a line management relationship.…”