http://doi.org/10.33698/NRF0052 – Jogindra Vati, Indarjit Walia, Karbi Das, Suksham Chopra
Abstract: A descriptive study to identify characteristics that nursing students look for in their role model for clinical supervision was conducted in the college of nursing now upgraded as National Institute of Nursing Education, PGIMER Chandigarh during year 2001-2002. Two pre-tested 80-items questionnaires related to roles, functions and behaviour of clinical supervisor, were administered to a sample (N=220) consisting of three groups: (1) students of B.Sc. nursing 4 years (n=158), (2) Post basic B.Sc. nursing (n=45) and (3) M.Sc. nursing (n=17). The data revealed that students have identified five very important elements of good supervision viz. knowledge, technical, organizational, conceptual and human skills that a clinical teacher needs to have. The highest scores were given to ‘knowledge’ of the supervisor followed by ‘human skills’. The least weightage was given to ‘conceptual skills’. No significant difference was observed among three categories of students regarding their perception on characteristics in totality of a good clinical supervisor. The students have identified their role model as knowledgeable, skilled teacher, person, manager and a professional nurse. Thus knowing these characteristics of excellent role models would help the nurse educators to formulate strategies to recruit, retain and develop their clinical teachers.
Key words: Clinical supervision, Role model, Elements of supervision
Introduction
The nursing profession in India has vital role to play to meet the objectives of National Health Policy. The nurses are required to carry out multiple responsibilities to deliver the care up to the satisfaction of clients. In near future, they are also expected to be independent practitioners. So there is a challenge to the nurse educators to prepare the nurses to shoulder these types of responsibilities to meet the demands of people at large. The student nurses are the future nurses to provide the optimal quality care. They are not only required to have theoretical knowledge but also need to develop expected competencies and skills in performing various nursing tasks. Teachers are there to help them to achieve the desired competencies through effective clinical teachings and supervision, which is one of, requites in the triad process of learning.
Supervision is highly individualized. None of the less, there are several principles and characteristics that are desirable in supervision. The qualities of mutual trust, morale, caring, mutual respect and confidence are the most important for setting a learning environment and motivating the students to learn. The emotional maturity, attitudes, wisdom, intelligence, empathy all reflect the personality of the supervisor, and also important ingredients for effective supervision2, 3 and also to mould the conduct of students.
Since supervision is a facilitating process, a learning climate is must and good supervisors try to create that environment. Good supervisors are those who have knowledge in the specialties, practice areas in which they are working and able to communicate their knowledge in an understandable way. They discuss with the students their previous knowledge and experiences and interact with them. They are required to have clinical, teaching, technical, conceptual and human skills to maximize students learning. So they need to be good role model as teacher, clinician and person. Whereas a good teacher banks heavily as being a value oriented affiliated person besides having knowledge. Hence supervision entails the situational use of personal characteristics, principles and skills that a supervisor should possess.
In nursing mostly the clinical instructors are the supervisors, who are responsible for students getting opportunity to practice relevant, nursing tasks in order to become independent. They are also responsible for ensuring that the students are sufficiently prepared to demonstrate the desired skills as per the course objectives. They also try to establish a schedule of supervision that provides opportunity for two way communication.
The students are quick to recognize the teacher supervisor who is much interested in them as in her subject area. They are the consumers of the teaching and they know what they can or cannot consume. They are the best determinants to express their role model supervisors and also the best judges to evaluate the type of clinical supervision and teaching they need. A number of studies undertaken on identifying the characteristics of supervisors based on perception of supervisee, students in developed countries but in Indian scenario, reviewed literature lacks in studies on this issue. Moreover, knowing the characteristics of excellent role model can help nurse educators to evaluate the clinical teaching skills of their clinical supervisors and also to plan out the strategies accordingly.
Objective
To identify and describe the characteristics of good clinical supervisor to whom they look as their role model.
Material and methods
The study was conducted in College of Nursing now upgraded as National Institute of Nursing Education PGIMER Chandigarh. This college is affiliated with Panjab University and presently running three programmes in nursing viz. B.Sc. nursing (4years), B.Sc. nursing (Post Basic) of two years and M.Sc. nursing of two years. Except B.Sc. nursing (4years), rest candidates are the in-service nurses, having the experience of clinical, administrative or teaching, whereas B.Sc. nursing (4years) students directly enter into the programme after 10+2 with medical stream.
During the training period, the students are posted in the hospital and the community mostly during the morning hours to complete the required hours in fundamental of nursing, medical surgical nursing, community health nursing, pediatric nursing, mental health nursing and obstetric and midwifery. The clinical teachers in their respective assigned areas continuously supervise B.Sc. nursing students, whereas M.Sc. students need not be supervised so constantly.
The target population consisted of all the students undergoing training. All the students who were willing to participate in the study were taken as study subjects, whose number was 220. The data was gathered during the year 2001-2002 after seeking the permission from the competent authority. The class coordinators were contacted to fix up the time for data collection. Thereafter, the class teachers were informed accordingly. The lists of students of all the classes were taken from the office. The purpose of the study was explained to the subjects and verbal consent was sought from them. Since the Institute funded the project, so it was cleared by the ethical committee.
A profile data sheet and two pre tested 80- items ‘Clinical Supervisor Elements Importance Scale’ (CSEIS) related to roles, functions and behaviour of the clinical supervisor/teacher which all together bring forth the satisfaction to the students, was administered to them. There were 9 items on ‘knowledge and skill’, 16 items on ‘technical skills’, 14 items on ‘organization skills’, 21 items on ‘conceptual skills’ and 20 items on “human skills’. The subjects were asked to give their opinions regarding the supervisor to whom they look as the role model against each item on 5 point scale ranging from ‘Very important’ to ‘Not important’ (Very important=5, Important=4, Somewhat important=3, least important=2 and Not important=1). The average time taken by the students was 40 to 60 minutes. The collected data was analysed quantitatively. The descriptive statistics was used and data was analysed by using Microsoft Excel.
Results
Characteristics of subjects
The mean age of B.Sc. nursing (4years) students was 19.8 years (SD= ±1.5), age range 17-23 years. Post Basic students were of age ranging 24-43 years with the mean age 31.2±5.1 years and the mean age of M.Sc. students were 31.65±8.2 years and age range was 24-52 years. Nearly half of the students (53.2%) were of the age range between 20 to 30 years and only one subject was of the age of 52 year. All the B.Sc. nursing (4 years) students were unmarried. In post basic nearly half of the students were married and in M.Sc. nursing more than 70% students were married. Three M.Sc. students were postgraduate in arts, whereas in Post Basic only one student was postgraduate and one student was graduate.
About half of the students of M.Sc. and Post Basic nursing were having less than five years of experience. Two students of Post Basic were with more than 15-20 years of experience in the job and 2 students of M.Sc. nursing were having more than 20 years of experience. Designation wise, majority of students (97.8% of Post Basic and 64.7% of M.Sc. nursing) were working at the operational level. Three subjects at supervisory level, 2 subjects were holding the position of administrative level and 2 were the nurse educators. Habitat wise, out of 220, about half of the subjects belonged to Punjab state, about one fifth were from Chandigarh and Himachal Pradesh each, 14 were from South, 5 from Haryana and five from J & K.
Students’ perception towards
Characteristics of good clinical supervisor
Knowledge Domain
Of 220 students, more than 80% were of the opinion that it is very important for the clinical supervisor to be knowledgeable regarding the current nursing practices and should be skilled enough to demonstrate nursing procedures. She should also be aware of the articles and equipments available in the ward for the students to practice. About 75% of them expressed that the teacher need to be aware of the nursing standards and legislation.
About 65% students felt that the supervisor should be thorough with patients, patients’ diagnosis and treatment and also have the knowledge regarding ward policies, rules and regulation. Same number of subjects responded that they should be able to demonstrate skill in data gathering in an organized way. Whereas less than 60% students perceived that it is necessary for the clinical supervisor to have the knowledge regarding medical procedures and practices.
Organizational Skill Domain
Majority of subjects (80.5%) said that a clinical supervisor should plan required clinical experience in such a way that each student gets equal opportunity to practice. She should plan duty timings of their rotation well in advance (68%) and explain them exactly what is expected from them (63.2%). She needs to observe punctuality (68%) and encourage them to maintain discipline in the clinical area (64.5%).
Nearly 60% students expressed that the nurse supervisor should check the students for maintaining clean and tidy uniform and she should try to develop guidelines for the assigned work and should communicate the students about their abilities and performance time to time. Majority of subjects did not find very important for the clinical supervisor to punish the students when not reporting in time in the clinical area, not doing assignments properly and when not in proper uniform.
Technical Skill Domain
About 78% subjects responded that a good clinical supervisor is one who should be aware of the needs of each student for self confidence, security and motivates the students to develop interest in patient care. She should be able to demonstrate the nursing procedures confidently and successfully (76.8%) and should be able to provide adequate learning environment for the students to practice nursing procedures (70.9%). Around 60% of them opined that she should use simple terms to teach nursing procedures, should use examples wherever possible, can also use simulation and bedside teachings to demonstrate various skills (71.4%).
To develop skills, it is very important for the clinical supervisor to give enough time for practice. She should recognize the student’s ability as to how they are identifying patient’s problems and carry out the procedures, evaluate the care given by them and she should allow the students to recognize and correct the errors.
Majority of them felt that being the best supervisor she should not get angry when a student fails to do nursing procedures correctly even after repeating the demonstrations and should only use observatory method to supervise them.
Conceptual Skills Domain
More than 65% students were of the opinion that a good supervisor behaves like an experienced and mature teacher and takes a lot of effort in developing clinical skill so that the students can improve their clinical proficiency. She should be a guiding spirit and role model to the students in the clinical area. She should be free from personal bias and always encourage the students to have good working relationship and interpersonal relationship with other students.
About 50% students expressed that it is important for a good clinical teacher to have a high clinical standard for her student and she should consult the staff involved in the care of patients. She should believe in firm action than just saying. Almost the same number of students opined that a supervisor should have a pleasant speaking voice, share joys with students and counsel them when need arises. She should also inculcate the habits among them to give respect to the teacher.
Most of the students did not favour that she should evoke emotions in students and try to find out the background of students. There is no need that she takes her own evaluation and positive criticism of learning experiences from students.
Human Skills Domain
Data revealed that more than 70% students find very important for a good supervisor to be objective and fair while evaluating the performance of students. She should have the ability to support and encourage (73.5%) and should treat each student as an individual (72.7%). She should encourage and motivate them to improve their skills and should solve their problems in a relaxed and approachable manner (70.8%). She should be available in the clinical area (67.7%) to help the students (65.5%) and should allow them to express their views freely (66.4%).
More than 50% students expressed that she should be sensitive to students’ feelings, their problems and should try to understand the world through students’ eyes. She should be able to convey a sense of warmth and respect to the students (57.7%), try to alleviate their anxiety (54.1%) and accept them as they are whether one likes them or not (50.9%).
Table 1 depicts the students’ ratings on elements of good supervision. Overall the students perceived maximum 400 scores and minimum 279; out of 400 scores for the items of all five elements of good supervision with an average of 350.9 +26.9 and mean percentage were 87.73.
Table 1: Students ratings on elements of good clinical supervision N=220
| Elements of
supervision |
No. of
items |
Scores | ||
| Mean ±SD | Range | Mode | ||
| 1. Knowledge | 9 | 42.1± 2.7 | 32-45 | 45 |
| 2. Organizational skill | 14 | 61.3 ±5.7 | 31-70 | 63 |
| 3. Technical skill | 16 | 68.9 ±6.0 | 32-80 | 71 |
| 4. Conceptual skill | 21 | 90.4± 8.5 | 45-105 | 94 |
| 5. Human skill | 20 | 88.2 ±9.2 | 32-100 | 92 |
| In totality | 80 | 350.9 ±26.9 | 232-400 | 354 |
Rake wise, the highest scores were given by students for “knowledge of supervisor as one of the very important elements of good supervision. They rated maximum 45 scores and minimum 32 scores out of 45 with average of 42.1 2.7 (mode= 45, mean%=93.4). The second rank was given for the ‘human skills’ that a good clinical teacher should posses. For this element, the students rated maximum 100 scores and minimum 32 out of 100, with an average 88.2±9.2 (mode=92, mean %=88.2) this was followed organizing, technical and conceptual skills.
As per the training programme, M.Sc. students weighted the highest score for all the elements of good clinical supervision (Fig.2) followed by B.Sc. (Post Basic) and then B.Sc. nursing (4 years) students.
Table 2: Student’s ratings on elements of good clinical supervision as per their training background. N=220
|
Elements of supervision |
Scores as per training background | |||
| M.Sc. (N) | B.Sc. (PB) | B.Sc. (4 years) | Statistical significance
F df=2/217 |
|
| n=17 | n=45 | n=158 | ||
| Mean±SD | Mean±SD | Mean±SD | ||
| 1. Knowledge | 42.9 ± 2.3 | 42.5 ± 2.4 | 41.8 ± 2.8 | 2.02 p>0.05 |
| 2. Organizational skill | 64.1 ±4.7 | 63.3 ± 4.5 | 60.5 ± 5.8 | 7.06 p<0.01 |
| 3. Technical skill | 72.0 ± 5.4 | 70.2 ± 4.2 | 68.3 ± 6.4 | 4.46 p<0.05 |
| 4. Conceptual skill | 93.2 ± 9.2 | 90.6 ± 7.2 | 90.1 ± 10.1 | 1.03 p>0.05 |
| 5. Human skill | 90.3 ± 8.3 | 86.8 ± 7.9 | 88.4 ± 9.7 | 1.01 p>0.05 |
| In totality | 362.9 ± 27.0 | 353.2 ± 22.3 | 353.2 ± 28.1 | 2.28 p>0.05 |
Discussion
The findings of the present study revealed that majority of students perceived that a knowledgeable, skilled and clinical oriented teacher can supervise the students in a better way and they rank this element of supervision at the top. The reviewed literature also confirmed these findings and considered it very important as far as supervision is concerned. This aspect is also adapted as 1 practice centered model of clinical supervision and ranked it one of the top factors for the role model of clinical teacher.
Most of the students also felt that a clinical supervisor should be able to plan the rotation of the students, prepare the guidelines for the assigned work and the criteria of evaluating them. Similar views are also expressed by Barber (1987) under teaching models of nursing. She viewed that a supervisor should discharge the management functions where she should be concerned with planning, allocation and evaluation; and should be more supportive.
The subjects also verbalized that the supervisor should not punish the students, when not reporting in time in the clinical area, not doing the assignment properly and when not in uniform. But Nicklin Peter (1997) in her article viewed that clinical supervisor should be concerned with discipline and policies. She also mentioned that supervision is a facilitating process and supervisor should use problem-solving approach . More than 70% students in the present study expressed the same views.
The reviewed literature across the country reported that interpersonal behaviour and personality traits are perceived as very important characteristics of a good teacher1and very effective to mould the character and conduct of the students. About 82% of medical students also ranked this characteristic on the top. Similar responses were received in the present study from 86.13% students. Though they opined that clinical teacher should be a guiding spirit, should have pleasant speaking yet majority of them did not want any interference in their personal matters by their supervisors that could evoke emotions in them.
Since the supervision is a facilitating process rather than directing, the supervisor should use problem solving approach, should have analytical skills and should give constructive criticism. About 87%of subjects said that supervision should provide new learning 20. Similar responses were also expressed by more than 70% of students in the present study.
The findings also revealed that the students like the teacher who would be free from bias, has ability to support, encourage and sensitive to the students’ feelings. They ranked this element next to knowledge domain. Other studies also reported that a good supervisor should have the ability to understand the students, grasp the situation and should be able to understand the human behaviour. Whereas thinking, feeling, involving, having and loving are the five genuine and penetrating pointers of advancement in quality teaching. The teacher needs to have nearness, cordiality and sympathy for the learners under countless constraints in particular. She needs to know the motivational maps and spurts of students. She also needs to be committed and proficient teacher, even nurse teachers were of the opinion that interpersonal skills work does influence the interaction competencies in teaching student nurses’ human skills.
So based on the study findings it is concluded that nursing students both under graduate and graduate described the characteristics of their role model as knowledgeable, skilled, proficient teacher, as a person with heart and principles, as an efficient manager and a professional nurse for effective clinical supervision. Thus the nurse educators to formulate the strategies to recruit, evaluate, retain and develop the clinical teachers can use these findings as criteria.
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