Jurnal Supervisi

Jurnal Ilmu Keperawatan. Vol.II.No.2.
September 2014
PENGARUH SUPERVISI KLINIS TERHADAP

PENATALAKSANAAN UNIVERSAL
PRECAUTION OLEH PERAWAT (LITERATURE
REVIEW)
Ira Mehara Wati
Fakultas Ilmu keperawatan
Universitas BSI
Jalan Sekolah Internasional No.1-6 Antapani, Bandung 40282
iramehara@gmail.com
Abstract - The cases of nosocomial infection and low safety nurses Is still rampant and it make health
care provided has not been said to be good. Culture of safety for patients or nurses are influenced by
universal precaution containment procedures that can not be separated with clinical supervision.
Implementation of clinical supervision is to help evaluate nursing actions so in accordance with the
standard. During the implementation of clinical supervision in the management of universal
precautions has not been done in a structured and not optimally. This article aims to identify and
review of previous studies related to the influence of universal precautions supervise management. The
method used is to review the literature of nursing, medicine, and public health from tahun1987 to 2013
using 12 related articles of universal precautions and supervision as reference. The results of the
literature review showed that clinical supervision affect the application of universal precautions by
nurses. The conclusion obtained is that clinical supervision is very instrumental in the achievement of
the implementation of nursing practice to conform to the standards that have been defined, in this case
in order to achieve universal culture of safety precautions so as to prevent infection and accidents for
nurses.
Keyword : Universal Precautions, Supervision, Safety Culture, Infection, Nosocomial
Bibliography: 29, 1998-2013
Abstrak - Masih maraknya kasus infeksi nosocomial dan rendahnya keselamatan kerja perawat
membuat pelayanan kesehatan yang diberikan belum dikatakan baik. Budaya safety bagi pasien atau
perawat dipengaruhi oleh penatalaksaan universal precaution yang tidak terlepas dengan pengawasan
atau supervisi klinis. Pelaksanaan supervisi klinis dimaksud untuk membantu mengevaluasi tindakan
keperawatan sehingga sesuai dengan standar. Selama ini pelaksanaan supervisi klinis dalam
penatalaksanaan universal precaution belum dilakukan secara terstruktur dan optimal. Artikel ini
bertujuan untuk mengidentifikasi dan mengulas penelitian sebelumnya terkait pengaruh supervisi
terhadap penatalaksanaan universal precaution.
Metode yang digunakan adalah mengulas literatur keperawatan, kedokteran, dan kesehatan masyarakat
dari tahun1987 sampai 2013 dengan menggunakan 12 artikel terkait universal precaution dan supervisi
sebagai referensi
Hasil ulasan literatur menunjukan bahwa supervisi klinis berpengaruh terhadap penerapan universal
precaution oleh perawat.
Kesimpulan yang didapatkan adalah bahwa supervisi klinis amat berperan dalam tercapainya
penerapan praktik keperawatan agar sesuai dengan standar yang sudah ditetapkan, dalam hal ini adalah
universal precaution guna tercapainya budaya safety sehingga mencegah infeksi dan kecelakaan kerja
bagi perawat.
Kata Kunci : Universal Precaution, Supervisi, Budaya Safety, Infeksi, Nosocomial

Bibliografi : 29, 1998-2013
138
Jurnal Ilmu Keperawatan. Vol.II.No.2.September 2014
PENDAHULUAN yang meneliti tentang pengaruh supervisi

terhadap penatalaksanaan universal precaution.
Perilaku keselamatan atau safety
merupakan salah satu hal penting yang perlu METODE PENELITIAN
untuk diperhatikan guna melindungi perawat
dalam memberikan palayanan dan pasien selaku Literatur yang digunakan adalah artikel
pengguna pelayanan. Masih maraknya kasus sejak tahun 1998 sampai 2013 dengan pencarian
infeksi nosocomial pasien atau kecelakaan kerja menggunakan Medline, PubMed, Biomed
pada perawat menunjukan masih kurangnya Central, AJAN, EBSCO, dan ProQuest. Istilah
budaya safety yang dilakukan perawat. Angka yang digunakan dalam pencarian adalah universal
kejadian infeksi di rumah sakit di Indonesia precaution, infeksi, nosocomial, supervisi, safety,
masih cukup tinggi dan diperkirakan sekitar 38% dan petugas kesehatan. Daftar referensi dari
- 73% perawat pelaksana pernah mengalamai artikel tersebut juga dicari. Kriteria inklusi
Needle Stick Injury (NSI). Padahal perawat meliputi penelitian terkait dengan pelaksanaan
memiliki peran penting dalam budaya safety, universal precaution oleh tenaga kesehatan di
terbukti dengan 56% - 60% tenaga kesehatan di lahan praktik dan proses supervisi di ruangan.
rumah sakit adalah perawat.
Pelaksanaan universal precaution harus Penulis melakukan pencarian literatur,
dilakukan agar tidak terjadi kontaminasi silang mengidentifikasi, lalu mengambil data. Penilaian
ataupun infeksi pada perawat dan pasien. Tujuan terhadap kualitas penelitian yang dilakukan oleh
universal precaution sendiri adalah untuk penulis secara mandiri, menggunakan pendekatan
mencegah transmisi dari pathogen berbahaya terstruktur dengan kriteria inklusi dan eklusi
yang berasal dari darah dan cairan tubuh saat sebagai acuan.
melakukan tindakan yang dilakukan oleh petugas
kesehatan dengan menghindari kontak langsung PEMBAHASAN
dengan cairan tubuh pasien karena darah dan
segala cairan tubuh yang berasal dari pasien Berdasarkan pada 28 literature yang
berpotensi menginfeksi. Namun hal ini masih dianalisa, sebanyak 12 literature memiliki judul
kurang diterapkan oleh perawat selaku petugas dan abstrak yang relevan, dan sebagai tambahan
kesehatan. Risiko kerja yang dapat dialami sebanyak 16 judul digunakan sebagai referensi.
perawat berupa cedera musculoskeletal, luka, Pada penelitian yang ditelaah dalam artikel
infeksi, perubahan dalam kesehatan mental, ini belum ada yang menggunakan penelitian
penyakit jangka panjang kardiovaskuler, Randomized Control Trial (RCT), keseluruhan
metabolism, dan neoplasia. Bersadarkan kondisi penelitian hanya sebatas studi observasional
tersebut maka perlu adanya pengawasan dan tentang pengaruh supervisi terhadap
perhatian oleh manajer dalam pelaksanaan penatalaksanaan universal precaution.
universal precaution. Berdasarkan review artikel, ditemukan bahwa
Supervisi merupakan proses formal dari supervisi klinis berpengaruh pada pelaksanaan
belajar dan dukungan professional yang universal precaution.
memungkinkan perawat praktisi untuk
mengembangkan pengetahuan dan kompetensi, PEMBAHASAN
menerima tanggung jawab dalam praktiknya dan Unversal precaution merupakan salah satu
meningkatkan perlindungan terhadap diri, pasien, tindakan yang dilakukakn guna mencegah infeksi
dan pelayanan keperawatan yang aman dalam dan penularannya guna ditemukan bahwa
kondisi yang kompleks. Pengawasan dengan perilaku safety perawat di rumah sakit masih
pendekatan yang baik mampu merubah kurang. Penelitian Dewi (2011) yang dilakukan
paradigma dan perilaku seseorang yang di insatalasi rawat inap menunjukan perawat yang
disupervisi sehingga menjadi lebih baik. Tetapi, mempersepsikan dirinya masih kurang dalam
pelaksanaan supervisi terhadap universal menerapkan perilaku keselamatan perawat
precaution belum banyak berjalan. Hal ini sebanyak 48%.
dikarenakan masih kurangnya pemahaman dan Selain kurangnya pengetahuan akan
kesadaran perawat terhadap pentingnya universal precaution, perawat juga dinilai
pelaksanaan universal precaution dan supervisi. memiliki kepatuhan yang rendah. Kepatuhan
Artikel ini bertujuan untuk perawat terhadap pencegahan dan pengendalian
mengidentifikasi dan menggambarkan penelitian infeksi merupakan faktor yang sangat penting.
139
Hal ini didukung oleh penelitian Bianco et al ( mengembangkan dan meningkatkan kualitas dari
2013) tentang pelaksanaan universal precaution pelayanan. Walaupun secara konseptual
dalam mencegah transmisi virus hepatitis C di pelaksanaan supervisi berbeda-beda namun
unit hemodialisa bahwa kepatuhan lebih tujuannya tetap sama. Selain itu, supervisi
berpengaruh daripada pengetahuan perawat itu sebaiknya dilakukan setiap dua minggu sekali
sendiri yang didasari adanya kesadaran perawat dengan supervisor yang memang sudah benar--
akan bahaya transmisi virus. Dengan kata lain benar paham tentang tugasnya dan hal-hal yang
peluang perawat untuk tertular penyakit amat yang disupervisi. Waktu supervisi ideal adalah 15
sangat tinggi. Disamping itu pengaruh dari rekan menit sampai 30 menit, dan paling ama 45 menit
kerja terhadap perilaku seseorang dalam sampai 60 menit.Selain itu, supervisi klinis amat
pengguanaan alat pelindung juga berperan sangat penting karena amat mempengaruhi
(Cuming, 2009). Oleh karena itu, perlu adanya kemampuan kerja dalam meningkatkan
pengawasan terhadap sesame perawat. Dalam keselamatan dan menjadi standar kesehatan
peraktiknya peran dan fungsi manajer dalam hal professional (Dawson et al, 2012).
ini adalah untuk mempengaruhi perilaku perawat
dalam menerapkan keselamatan dan menetapkan PENUTUP
aturan, memperkuat norma dan sikap yang
berkaitan dengan praktik perawat itu sendiri Kesimpulan
(Feng et al, 2011). Hasil ulasan artikel yang dilakukan pada
Supervisi memegang pengaruh terhadap 12 jurnal tentang pengaruh supervisi klinis
penatalaksanaan universal precaution, dimana terhadap penatalaksanaan universal precaution
pada supervisi klinis bukan hanya merubah oleh perawat dapat disimpulkan bahwa supervisi
perilaku perawat yang melaksanakan universal klinis mempengaruhi terhadap penatalaksanaan
precaution tetapi juga menimbulkan kesadaran. universal precaution oleh perawat. Dimana
Dowson (2013) dalam penelitiannya yang supervisi klinis selain menambah pengetahuan
melihat pengaruh supervisi terhadap universal perawat juga merubah perilaku perawat dalam
precaution mengungkapkan walaupun supervisi melaksanakan tugas karena menimbulkan
klinis bukanlah hal utama yang wajib dilakukan kesadaran dari perawat yang disupervisi guna
namun berpengaruh terhadap perubahan untuk tercapainya budaya safety sehingga mencegah
menjadi lebih baik. mempengaruhi kemampuan infeksi dan kecelakaan kerja bagi perawat. Maka
kerja dalam meningkatkan keselamatan dari itu, perlunya pelaksanaan supervisi klinis
Sejalan dengan penelitian yang dilakukan terhadap perawat dan bukan hanya pelaksanaan
oleh Yulita (2013) dimana ia membedakan antara universal precaution saja namun juga segala
kelompok control dan kelompok kasus yang tindakan keperawatan lainnya agar sesuai dengan
diberi intervensi supervisi dan yang tidak standar yang telah ditetapkan dan meningkatkan
intervensi supervisi. Kelompok dengan intervensi standar pelayanan keperawatan.
pelaksanaan supervisi, sebanyak 54,63% berubah
menjadi lebih baik dalam pelaksanaan universal REFERENSI
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142
Pengaruh Supervisi Metode Klinis Terhadap Kelengkapan Dokumentasi
Asuhan Keperawatan di RSUD . H Soewondo Kendal
Nunik Wahyu Lestari*), Erni Suprapti**). Achmad Solechan***)
*)
Mahasiswa Program Studi S1 Ilmu Kperawatan STIKES Telogorejo Semarang
**)
Dosen Program Studi S1 Ilmu Keperawatan Universitas Muhammadiyah Semarang
***)
Dosen Sistim Informatika STIMIK PROVISI Semarang
ABSTRAK
Dokumentasi asuhan keperawatan merupakan pencatatan asuhan keperawatan yang dilakukan oleh
perawat secara lengkap mulai dari pengkajian, diagnosa, pelaksanaan dan evaluasi. Pendokumentasian
keperawatan merupakan hal yang sangat penting dikarenakan pendokumentasian merupakan bukti
perawat telah melakukan tindakan kepada pasien. Melihat manfaat dan pentingnya pendokumentasian
keperawatan Maka perlu adanya kontrol terhadap pendokumentasian asuhan keperawatan yaitu dengan
adanya kegiatan supervisi. supervisi metode klinik dapat meningkatkan kelengkapan dokumentasi asuhan
keperawatan. Penelitian ini bertujuan untuk mengetahui pengaruh supervisi metode klinis terhadap
kelengkapan dokumentasi asuhan keperawatan di RSUD Dr. H Soewondo Kendal. Desain penelitian ini
adalah quasi experimental pre-post test, jumlah sampel 35 responden dengan teknik saturation sampling.
Hasil penelitian ini menunjukkan terdapat pengaruh supervisi metode klinis terhadap kelengkapan
dokumentasi. Terlihat dari sebelum dilakukan supervisi metode klinis terdapat 26 dokumentasi askep
dengan kategori tidak lengkap dan setelah dilakukan supervisi metode klinis terdapat 25 dokumentasi
askep dalam kategori lengkap, dengan nilai p value= 0,000. Rekomendasi hasil penelitian ini adalah agar
melakukan supervisi metode klinis disetiap ruangan untuk menghasilkan dokumentasi yang lengkap.
Kata Kunci : Dokumentasi asuhan keperawatan dan supervisi metode klinis
ABSTRACT
Documentation of nursing care is a recording of nursing care performed by nurses complete ranging from
assessment, diagnosis, implementation and evaluation. Documentation of nursing is very important
because the documentation is evidence of nurses to patients already taking action. Seeing the benefits and
importance of nursing documentation Hence the need for control of documentation of nursing care is the
presence of supervision activities. methods of clinical supervision can improve the completeness of the
documentation of nursing care. This study aims to determine the effect of clinical supervision on the
completeness of documentation methods of nursing care in hospitals Dr. H Soewondo Kendal. This study
design is quasi-experimental pre-post test, the number of respondents with 35 samples saturation
sampling technique. The results of this study indicate there are significant clinical supervision methods
on the completeness of the documentation. Seen from before there were 26 clinical supervision method
with a category of nursing documentation is not complete and after the clinical supervision method there
are 25 categories of nursing documentation complete, with p value = 0.000. Recommendations resulting
from this research is that clinical supervision in every room of the method for generating complete
documentation.
Keywords: Documentation of nursing care and supervision of clinical methods
Pengaruh Supervisi Metode Klinis Terhadap Kelengkapan . . . (N. W. Lestari, 2014) 1

PENDAHULUAN Hasil penelitian Diyanto (2007) mengenai
Pendokumentasian adalah pencatatan dari “Analisis Faktor-Faktor Pelaksanaan
tindakan asuhan keperawatan mulai dari Dokumentasi Asuhan Keperawatan di Rumah
pengkajian, diagnosa, pelaksanaan dan Sakit Umum Daerah Tugurejo Semarang”
evaluasi. Dokumentasi merupakan aspek menunjukan bahwa kelengkapan pengisian
penting dari praktek keperawatan karena berisi dokumentasi oleh perawat masih kurang,
catatan-cataan yang berguna untuk penatalaksanaan pengisian dokumentasi
komunikasi, tagihan, finansial, edukasi, asuhan keperawatan dengan kategori kurang
pengkajian riset dan audit (Muhlisin, 2011, (48%), sedang (35%) dan baik (17%).
hlm. 29). Dalam asuhan keperawatan, Dikarenakan pengarahan dan bimbingan tidak
pendokumentasian keperawatan merupakan hal pernah dilakukan oleh Kepala Ruang.
yang sangat penting dikarenakan Observasi hanya difokuskan terhadap Catatan
pendokumentasian merupakan bukti perawat keperawatan pasien yang akan pulang saja.
telah melakukan tindakan kepada pasien Evaluasi juga tidak dilakukan oleh Kepala
(Nursalam, 2001, hlm. 77). Ruang. Faktor penghambat yang dihadapi
dalam pendokumentasian askep diantaranya
Dokumentasi dalam pelayanan keperawatan tidak seimbangnya jumlah tenaga perawat
adalah bagian dari kegiatan yang dikerjakan dengan pekerjaan yang ada, formatnya terlalu
oleh perawat setelah memberi asuhan panjang, perawat harus mendampingi visite
keperawatan kepada klien. Dokumentasi dokter, dan malas.
keperawatan mempunyai porsi yang besar dari
catatan klinis klien yang menginformasikan Hasil penelitian yang dilakukan oleh Aini
faktor tertentu atau situasi yang terjadi selama (2013) di Ruang Rawat Inap RSUD
asuhan dilaksanakan. Di samping itu Kanjuruhan Kepanjen Malang mengenai
dokumentasi dijadikan sebagai wahana “Hubungan Beban Kerja Perawat Dengan
komunikasi dan koordinasi antar profesi Pendokumentasian Asuhan Keperawatan”
(interdisipliner) yang dapat dipergunakan menunjukan bahwa perawat yang mempunyai
untuk mengungkap suatu fakta aktual untuk beban kerja berat cenderung kualitas
dipertanggung jawabkan (Nursalam, 2008, dokumentasinya hanya 15%, yang mempunyai
hlm. 144). beban kerja sedang cenderung kualitas
dokumentasinya hanya 52%. Berdasarkan hasil
Keberadaan dokumentasi baik berbentuk penelitian tersebut didapatkan taraf signifikan
catatan maupun laporan akan sangat membantu 0,01 diperoleh nilai koefisien rho 0,362 dan
komunikasi antar sesama perawat maupun nilai p≤0,024 artinya bahwa ada hubungan
disiplin ilmu lain dalam rencana pengobatan yang bermakna antara beban kerja dengan
dan penyembuhan klien (Hutahaean,2010, pendokumentasian. Dari penelitian di atas
hlm.85). dapat disimpulkan bahwa beban kerja sedang
maupun beban kerja berat menunjukan kualitas
Menurut Setiyarini (2004 dalam Soeroso, dokumentasinya masih sangat jauh dari
2002, hlm. 140) mengemukakan faktor yang memadai, yang akibatnya tindakan
mempengaruhi dalam pelaksanakan keperawatan tidak akurat sehingga nilai
pendokumentasian adalah pengetahuan, usia pelayanan menurun.
dan motivasi. Kurang patuhnya perawat dalam
menerapkan catatan dokumentasi asuhan Penelitian yang dilakukan Martini (2007)
keperawatan akan berakibat rendahnya mutu mengenai “Hubungan Karakteristik Perawat,
kelengkapan dokumentasi. Sikap, Beban Kerja, Ketersediaan Fasilitas
Dengan Pendokumentasian Asuhan
Keperawatan di Rawat Inap BPRSUD Kota
2 Jurnal Ilmu Kperawatan dan Kebidanan (JIKK)

Salatiga” menunjukan pengetahuan perawat implementasi tidak lengkap dan 12
52% yang mempunyai pengetahuan baik p dokumentasi implementasi lengkap, 18
value 0,0001. Sikap yang baik mencapai 57% dokumentasi evaluasi tidak lengkap dan 2
p value 0,000. Beban kerja sedang 37% p value evaluasi dokumentasi lengkap.
0,011. Format tersedia 61% p value 0,001.
Standar asuhan keperawatan tersedian Menurut hasil wawancara dengan kepala
59% p value 0,001 serta hasil Ruang Flamboyan untuk kelengkapan
pendokumentasian asuhan keperawatan dokumentasi akan dilakukan pada saat pasien
penkajian 43%, diagnosa 29,6%, perencanaan akan pulang dikarenakan jumlah perawat di
keperawatan 29,8%, tindakan 57,8%, evaluasi ruang flamboyan hanya 19 perawat dengan
53,4%, catatan asuhan keperawatan 69%. Hasil kapasitas 58 pasien. Menurut Bahtiar (2010,
analisis statistik untuk variabel pengetahunan, hlm. 80) kontrol terhadap pendokumentasian
sikap, beban kerja serta fasilitas ada asuhan keperawatan yaitu dengan adanya
berhubungannya dengan pendokumentasian kegiatan supervisi.
asuhan keperawatan, sedangkan untuk variabel
umur, masa kerja dan pendidikan tidak ada Supervisi metode klinis adalah suatu
hubungan. pengamatan atau pengawasan terhadap
pelayanan keperawatan yang diberikan oleh
Penelitian yang dilakukan oleh Pribadi (2009) seorang perawat selanjutnya dibandingkan
mengenai “Analisis Pengaruh Faktor dengan standar keperawatan, yang bertujuan
Pengetahuan, Motivasi, Dan Persepsi Perawat untuk membantu perawat pelaksana dalam
Tentang Supervisi Kepala Ruang Terhadap mengembangkan profesionalisme sehingga
Pelaksanaan Dokumentasi Asuhan penampilan dan kinerjanya dalam pemberian
Keperawatan” di dapatkan hasil bahwa asuhan keperawatan meningkat serta
pelaksanaan dokumentasi asuhan keperawatan diharapkan pendokumentasian asuhan
di RSUD Kelet Jepara dalam kategori baik keperawatan juga akan meningkat (Kuncoro,
(58%) dan kategori tidak baik (41,9%). Ada 2010, hlm. 108).
hubungan faktor pengetahuan perawat terhadap
pelaksanaan dokumentasi asuhan keperawatan Dari fenomena tersebut peneliti tertarik untuk
(p value = 0,007), ada hubungan faktor melakukan penelitian tentang “Pengaruh
motivasi perawat terhadap pelaksanaan Supervisi Metode Klinis Terhadap
dokumentasi asuhan keperawatan (p value = Kelengkapan Dokumentasi Asuhan
0,0001), ada hubungan faktor persepsi perawat Keperawatan”.
mengenai supervisi terhadap pelaksanaan
dokumentasi asuhan keperawatan (p value METODE PENELITIAN
=0,007). Penelitian ini termasuk pra eksperimen dengan
bentuk rancangan one group pretest-postest.
Dari hasil studi pendahuluan yang dilakukan di Pengambilan sampel dilakukan dengan teknik
RSUD Dr. H Soewondo Kendal, berdasarkan saturation sampling, yaitu dengan mengambil
observasi yang dilakukan di Ruang Flamboyan semua anggota populasi menjadi sampel
dan Ruang Kenanga dari 20 sampel (Nasir, 2011, hlm.228).
dokumentasi asuhan keperawatan di dapatkan
17 dokumentasi pengkajian tidak lengkap dan Populasi dalam penelitian ini adalah semua
3 dokumentasi pengkajian lengkap, 10 perawat yang bekerja di ruang Flamboyan dan
dokumentasi diagnosa tidak lengkap dan 10 Kenanga. Sedangkan sampel yang digunakan
dokumentasi diagnosa lengkap, 5 dokumentasi dalam penelitian ini adalah perawat bangsal
penyakit dalam Ruang Flamboyan dan Ruang
intervensi tidak lengkap dan 15 dokumentasi
Kenanga RSUD Dr. H. Soewondo Kendal
intervensi lengkap, 8 dokumentasi sebanyak 35 responden. Dalam melakukan

pengumpulan data pada penelitian ini dengan usia ≤35 tahun sebanyak 31 (88,6
digunakan alat ukur dengan lembar observasi %) responden. Sementara jenis kelamin
checklist dokumentasi asuhan keperawatan. responden terbanyak adalah perempuan
sebanyak 23 (65,7%). Berdasarkan tingkat
Berdasarkan uji normalitas data menunjukan
hasil bahwa kelengkapan dokumentasi asuhan pendidikan responden paling banyak adalah
keperawatan sebelum dilakukan supervisi lulusan D3 keperawatan sebanyak 26
metode klinis didapatkan data berdistribusi (74,3%). Rata-rata lama kerja responden
tidak normal dengan nilai p value 0,007 adalah >5 tahun sebanyak 23 (65,7%).
(<0,05), Sedangkan variabel kelengkapan
dokumentasi asuhan keperawatan setelah Kelompok umur responden termasuk dalam
dilakukan supervisi metode klinis didapatkan dewasa muda, menurut Peaget (dalam
nilai p value= 0,000 (<0,005) yang juga Anwar, 2007) mengatakan pada usia
tergolong berdistribusi tidak normal. Dari hasil dewasa muda seseorang lebih fleksibel,
data diatas disimpulkan data berdistribusi tidak terbuka dan sangat adaptif. Peaget (dalam
normal maka uji korelasi yang digunakan Anwar, 2007) menyatakan bahwa
adalah Mac Nemar. seseorang pada usia ini lebih adaptif
sehingga dalam melakukan suatu prosedur
HASIL PENELITIAN DAN lebih cepat tanggap dan melakukannya
PEMBAHASAN dengan benar.
1. Karakteristik perawat berdasarkan usia,
jenis kelamin, tingkat pendidikan, dan Jenis kelamin terbanyak adalah perempuan
lama kerja sebanyak 23 (65,7%). menurut Bady (2007)
Tabel 1. profesi keperawatan memang lebih banyak
Distribusi Frekuensi Perawat Berdasarkan diminati kaum perempuan, mengingat
Usia, Jenis Kelamin, profesi keperawatan lebih dekat dengan
Tingkat Pendidikan, dan Lama Kerja di masalah mother instink.
Ruang Flamboyan dan Kenanga
RSUD Dr H. Soewondo Kendal Mayoritas pendidikan responden adalah
VariabelFrekuensiPresentasi D3. Menurut Wawan dan Dewi (2010, hlm.
17) pendidikan dapat mempengaruhi
Usia
seseorang termasuk juga perilaku seseorang
≤ 35 Tahun 31 88,6
akan pola hidup, pada umumnya makin
> 35 Tahun 4 11,4
tinggi pendidikan seseorang makin mudah
Total 35 100 menerima informasi. Individu yang dapat
Jenis Kelamin berinteraksi secara kontinue akan dapat
Laki – Laki 12 34,3 lebih biasa mendapatkan informasi.
Perempuan 23 65,7
Total 35 100 Lama kerja perawat rata-rata >5 tahun.
Tingkat Pendidikan Hasil penelitian menunjukan bahwa
S1 9 25,7 perawat yang bekerja >5 tahun mempunyai
praktik dokumentasi asuhan keperawatan
D3 26 74,3
dengan lengkap. Hal ini sesuai dengan
Total 35 100
Gibson (1997) yang menyatakan bahwa
Lama Kerja semakin lama seseorang bekerja, tingkat
< 5 Tahun 12 34,3 prestasi semakin tinggi, prestasi yang tinggi
>5 Tahun 23 65,7 berasal dari perilaku yang baik dalam hal
Total 35 100 ini perilaku yang baik untuk melakukan
dokumentasi asuhan keperawatan.
Berdasarkan Tabel.1 menunjukan hasil
bahwa perawat paling banyak yaitu perawat
4 Jurnal Ilmu Keperawatan dan Kebidanan (JIKK)

2. Kelengkapan dokumentasi asuhan keperawatan terlalu banyak, tidak ada
keperawatan hubunganya dengan gaji serta
a. Sebelum dilakukan supervisi metode kurangnya teguran dari atasan.
klinis
Tabel 2.
Distribusi Frekuensi Kelengkapan Jumlah perawat ruangan yang sangat
Dokumentasi Asuhan Keperawatan sedikit dengan kapasitas pasien dan
Sebelum Dilakukan Supervisi Metode beban kerja yang sangat banyak
Klinis di Ruang Flamboyan dan membuat perawat jarang menuliskan
Kenanga RSUD Dr H. Soewondo dokumentasi asuhan keperawatan secara
Kelengkapan lengkap, perawat biasanya hanya
Frekuensi %
Dokumentasi
menuliskan nama pasien tanpa nomer
Kurang lengkap 26 74,3
RM, tidak melengkapi data pemeriksaan
Lengkap 9 25,7
fisik pasien, tidak menuliskan analisa
Total 35 100
data, tujuan dan rencana tindakan, pada
b. Setalah dilakukan supervisi metode lembar implementasi perawat sering
klinis tidak menuliskan, evaluasi perawat
Tabel 3. sering tidak menuliskan catatan
Distribusi Frekuensi Kelengkapan Dokumentasi perkembangan pasien dan tidak
Asuhan Keperawatan Sebtelah Dilakukan mencantumkan paraf.
Supervisi Metode Klinis di Ruang Flamboyan
dan Kenanga di RSUD DR H. Soewondo
Kelengkapan Setalah 3 hari dilakukan supervisi
Frekuensi % metode klinis terjadi peningkatan dari
Dokumentasi
Kurang lengkap 10 28,6 26 (74,3%) dokumentasi asuhan
Lengkap 25 71,4 keperawatan tidak lengkap menjadi 25
Total 35 100 (71,4%) dokumentasi asuhan
keperawatan dalam kategori lengkap.
Berdasarkan hasil penelitian sebelum Didapatkan 87,20% perawat menuliskan
dilakukan supervisi metode klinis dokumentasi pengkajian secara lengkap,
didapatkan 26 (74,3%) dokumentasi 59,45% dokumentasi diagnosa dan
asuhan keperawatan dalam kategori intervensi dituliskan secara lengkap,
kurang lengkap. 94,28% dokumentasi implementasi
dituliskan secara lengkap dan 87,5%
Didapatkan hasil 35 responden hanya dokumentasi evaluasi dituliskan secara
61,80% yang menuliskan dokumentasi lengkap.
pengkajian secara lengkap, 79,42%
perawat menuliskan dokumentasi Supervisi yang dilakukan pada saat
diagnosa dan intervensi dengan lengkap, perawat pelaksana menuliskan atau
70% perawat menuliskan dokumentasi menisi dokumentasi sehingga supervisor
implementasi dengan lengkap dan dapat mengecek langsung hasil
52,75% perawat menuliskan dokumentasi yang dilakukan perawat
dokumentasi evaluasi dengan lengkap. pelaksana dan memberikan motivasi
Alasan perawat jarang untuk melengkapi untuk melengkapi dokumentasi. Hal ini
dokumentasi asuhan keperawatan salah menunjukan bahwa supervisi yang
satu faktornya karena kurangnya dilakukan dengan baik akan
pengawasan, pengontrolan terhadap meningkatkan pendokumentasian
dokumentasi asuhan keperawatan. asuhan keperawatan. hal ini didukung
Perawat merasa dokumentasi asuhan oleh penelitian yang dilakukan Wiyana
(2008) menyebutkan bahwa ada

perbedaan yang bermakna antara kinerja Supervisi klinik menjadi kerangka dari
perawat yang disupervisi kepala ruang akuntabilitas dan responsibilitas seorang
dilatih dan dibimbing 6 kali dan 3 kali perawat dalam melaksanakan tindakan
dengan yang disupervisi kepala ruang keperawatan (Royan College of Nursing,
dilatih tidak dibimbing dengan nilai p 2007). Keadaan seperti ini semakin
value=0,016. menguatkan penelitian yang dilakukan
Puguh, Hariyati & Handiyani (2013)
Hasil penelitian ini sesuai dengan hasil didapatkan kualitas tindakan perawatan
penelitian yang dilakukan Linggardini luka di RS PKU sebelum kepala ruang
(2010) yang menyatakan ada hubungan dilatih supervisi adalah 70% dari nilai
yang bermakna antara teknik supervisi total, setelah setelah
dengan pendokumentasian berbasis kepala ruang dilatih supervisi
komputer dengan nilai p value=0,032 menunjukan peningkatan dari
dan ada hubungan yang bermakna antara sebelumnya sebesar 70% menjadi 90%,
frekuensi supervisi dengan dengan p value=0,005, Yang artinya ada
pendokumentasian berbasis komputer perbedaan antara kualitas tindakan
dengan p value=0,002. perawatan luka sebelum dan setelah
disupervisi oleh kepala ruang yang
Menurut Pitman (2011) kemampuan dilatih supervisi.
supervisor adalah menyediakan
pelayanan yang berkualitas, karena Hasil penelitian lain yang mendukung
supervisi berperan dalam memberi hasil penelitian yaitu penelitian yang
dukungan, penjamin mutu asuhan, dilakukan Izzah (2003) yang
manajemen resiko dan mengatur menemukan hasil bahwa ada hubungan
penampilan. Kondisi seperti ini yang bermakna antara variabel frekuensi
menguatkan penelitian yang dilakukan supervisi dengan kinerja perawat
Saljan (2005) tentang pengaruh pelaksana dengan nilai p value=0,16,
pelatihan supervisi terhadap kinerja sehingga dari penelitian tersebut bisa
dengan hasil terdapat pengaruh yang disimpulkan bahwa supervisi sangat
signifikan antara pelatihan supervisi mempengaruhi kinerja perawat.
dengan peningkatan kinerja perawat
pelaksana.
3. Kelengkapan Dokumentasi Asuhan Keperawatan Sebelum dan Sesudah Supervisi Metode

Klinis
Tabel 4.
Kelengkapan Dokumentasi Asuhan Keperawatan Sebelum dan Sesudah Dilakukan Supervisi
Metode Klinis di Ruang Flamboyan dan Kenanga RSUD Dr. H Soewondo Kendal
Pre Supervisi Post Supervisi Metode Uji Mac Nemar
N
Metode Klinis Klinis P Value
Kurang Lengkap Lengkap
Kurang Lengkap 10 16 26
0,000
Lengkap 0 9 9
N 10 25 35
Berdasarkan Tabel.4 menunjukan sebagian mendapatkan supervisi metode klinis

besar dokumentasi asuhan keperawatan 65,7%. Hasil uji statistik menggunakan
yang lengkap dibuat pada responden yang Mac Nemar didapatkan nilai p value= 0,000

dengan taraf signifikan p<0,005, sehingga meningkat dan sacara otomatis
dapat disimpulkan bahwa ada pengaruh dokumentasi asuhan keperawatanpun akan
supervisi metode klinis terhadap lengkap. Supervisor harus dapat
kelengkapan dokumentasi asuhan memberikan pendampingan sesuai dengan
kondisi dan kemampuan anggota tim,untuk
keperawatan. hal ini sesuai dengan hasil
mencapai tujuan organisasi (Linggardini,
penelitian pada dokumentasi pengkajian 2010, ¶2). Hal ini sesuai dengan Gregor
mengalami kenaikan 25,4%, dokumentasi (ngatini, 1998) bahwa sikap pemimpin akan
diagnosa dan intervensi mengalami mempengaruhi motivasi bawahanya,
kenaikan 14,86%, dokumentasi sehingga akan mempengaruhi produktifitas
implementasi mengalami kenaikan 17,5%, kerja terutama dalam hal dokumentasi
dan dokumentasi evaluasi mengalami asuhan keperawatan.
kenaikan 28,79%.
Hal ini sesuai dengan hasil penelitian yang
dilakukan Syaifulloh (2009) tentang kepala
Tujuan supervisi keperawatan adalah untuk
ruang yang diberi pelatihan supervisi
mmberikan dukungan, memotivasi,
terbukti meningkatkan kemampuan dalam
meningkatkan kemampuan dan
mengendalikan emosi dengan tidak melakukan kegiatan supervisi. penelitian ini
membuat perawat pelaksana merasa dinilai sesuai dengan yang dikemukakan
dalam melakukan pekerjaan secara benar Notoatmojo (2009) menyebutkan
(Sugiharto, 2012, hlm. 25). Gilles (2001) pentingnya pelatihan bagi suatu organisasi
bahwa tujuan supervisi untuk melihat, adalah untuk memenuhi kemampuan dan
mengevaluasi dan meningkatkan tampilan
fungsi manager pada jabatan tertentu agar
kerja, kinerja dengan adanya supervisi
diharapkan kinerja perawat pelaksana mampu menjalankan fungsinya dengan
meningkat, termasuk dalamnya adalah baik.
dengan pendokumentasian keperawatan.
Hasil penelitian ini sesuai dengan hasil
Menurut Gilles (2001) mengemukaan penelitian yang di lakukan Pribadi (2009) di
salah satu metode supervisi yang dapat RSUD Kelet Jepara yang menunjukan
dilakukan adalah supervisor melihat bahwa ada hubungan yang signifikan antara
secara langsung bagaimana perawat supervisi dengan kelengkapan dokumentasi
pelaksana melakukan dokumentasi. asuhan keperawatan (p value=0,007),
Menurut Wiyana (2008) menunjukan bahwa faktor persepsi perawat
tentang supervisi yang dilakukan oleh
mengemukakan langkah-langkah kepala ruang mempengaruhi kinerja
supervisi langsung terkait dengan perawat dalam mendokumentasikan asuhan
pendokumentasian asuhan keperawatan keperawatan. penelitian ini memperkuat
meliputi memberi informasi kepada penelitian yang dilakukan Saljan (2005)
perawat pelaksana terkait yang akan tentang pengaruh pelatihan supervisi
disupervisi bahwa pendokumentasian terhadap kinerja dengan hasil terdapat
yang akan disupervisi, melakukan pengaruh yang signifikan antara pelatihan
supervisi asuhan keperawatan pada supervisi dengan peningkatan kinerja
saaat perawat melakukan perawat pelaksana.
pendokumentasian. Supervisi melihat
hasil pendokumentasian secara langsung Supervisi menjadi bagian penting untuk
dihadapan perawat. membantu meningkatkan tata kelola klinik
yang baik dengan memberi dukungan
Supervisi yang dilakukan di RSUD Dr. H penyediaan layanan kesehatan yang aman
Soewondo Kendal sebagian sudah baik. dan efektif sehingga sangat penting
Dengan adanya supervisi klinis diharapkan meningkatkan proses supervisi klinis
kinerja perawat dalam memberikan asuhan (Dawson, 2012). Hal ini memperkuat
keperawatan kepada pasien akan penelitian yang dilakukan Davis & Burke

(2011) pada penelitian efektifitas supervisi Hasil uji Mac Nemar didapatkan nilai p value
klinik bagi manager bangsal disimpulkan 0,000 yang artinya Ada pengaruh yang
bahwa supervisi klinis dianggap efektif dan bermakna antara supervisi metode klinis
membantu meningkatkan perawatan pasien. dengan kelengkapan dokumentasi asuhan
bahwa supervisi klinis dianggap efektif dan keperawatan di RSUD Dr. H Soewondo
membantu meningkatkan perawatan pasien. Kendal.
SIMPULAN SARAN
Perawat di ruang Flamboyan dan Kenanga 1. Bagi Manajemen Rumah Sakit
sebagian besar berusia ≤35 tahun yaitu Untuk menerapkan supervisi metode klinis
sebanyak 31 (88,6%), jenis kelamin perawat disemua ruangan untuk mendapatkan hasil
paling banyak perempuan yaitu 23 (65,7%), dokumentasi asuhan keperawatan yang
tingkat pendidikan perawat paling banyak lengkap dan mengadakan pelatihan bagi
Diploma 3 yaitu 26 (74,3%), lama kerja kepala ruang atau ketua tim dalam
perawat yang paling banyak yaitu >5 tahun kaitannya pelatihan supervisi metode klinis
sebanyak 23 (65,7%) perawat. yang kaitannya dengan dokumentasi asuhan
keperawatan.
Gambaran dokumentasi asuhan keperawatan di
ruangan sebelum dilakukan supervisis dengan 2. Bagi Institusi Pendidikan
metode klinis masih tergolong kurang lengkap Hasil penelitian ini dapat digunakan
dalam menuliskan dokumentasi askep. sebagai bahan pembelajaran tentang
Dokumentasi pengkajian sebanyak 61,80%, pentingnya fungsi pengawasan dalam
diagnosa dan intervensi 79,42%, implementasi manajemen khususnya supervisi metode
70% dan evaluasi 52,75%. Hasil dari klinis terhadap kelengkapan dokumentasi.
kelengkapan dokumentasi asuhan keperawatan Dapat menerapkan supervisi metode klinis
di ruangan didapatkan 25,7% yang menuliskan pada mahasiswa yang berada di lahan
dokumentasi secara lengkap dan 74,3 % tidak praktek.
menuliskan dokumentasi asuhan keperawatan
secara lengkap dan 74,3 % tidak menuliskan 3. Bagi Penelitian Selanjutnya
dokumentasi asuhan keperawatan kurang Untuk menerapkan atau memberikan
lengkap. standar asuhan keperawatan.
Kelengkapan dokumentasi asuhan

keperawatan di ruangan setelah dilakukan DAFTAR PUSTAKA
supervisi menggunakan metode klinis
semakin baik dan lengkap. Hasil Nursalam. (2001). Proses dokumentasi
kelengkapan dokumentasi dimasing bagian keperawatan konsep dan praktek.
menunjukan peningkatan, dari Jakarta: Salemba Medika.
dokumentasi pengkajian sebanyak 87,20%,
diagnosa dan intervensi sebanyak 94,28%, . (2008.). Proses dan dokumentasi
keperawatan konsep dan praktik.
implementasi 87,5%dan evaluasi 81,49%.
edisi 2. Jakarta: Salemba Medika.
Untuk kelengkapannya terdapat 71,4%
perawat menuliskan dokumentasi secara Muhlisin, A. (2011). Dokumentasi
lengkap dan hanya 28,6% yang menuliskan keperawatan. Yogyakarta : Goyen
dokumentasi asuhan keperawatan secara Publishing
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dokumentasi proses keperawatan.
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pengetahuan, motivasi dan persepsiperawat tentang supervisi terhadap pelaksanaan
dokumentasi asuhan keperawatandiruang rawat inap RSUD kelet provinsi jawa tengah di
Jepara. Tesis Magister Ilmu Kesehatan Masyarakat. http://eprints.undip.ac.id/16228/I/Ag ung-
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Available online at www.sciencedirect.com
ScienceDirect
Procedia - Social and Behavioral Sciences 205 (2015) 86 – 91
6th World conference on Psychology Counseling and Guidance, 14 - 16 May 2015
Supervision in Nursing: Latvian sample study

Kristaps Circenisa*, Jekaterina Jeremejevaa, Inga Millerea, Liana Deklavaa,
Arturs Papardea, Velga Sudrabaa
a
Riga Stradins University, Faculty of Public Health and Social Welfare, Anninmuizas bulvaris 26a, Riga LV- 1067, Latvia
Abstract
Burnout is a work related mental health impairment comprising three dimensions: emotional exhaustion, depersonalisation and
reduced personal accomplishment. Preventing and reducing work related burnout is of great importance not only with regard to
the quality of life of those affected or endangered, but also for preventing the economic losses which come about as a result of
absenteeism and job turnover. Supervision is known to be one of protective factors of burnout and professional effectiveness.
Purpose of study was to evaluate the effectiveness of supervision of nurses practicing in mental health hospital in Latvia aimed at
preventing burnout. To measure burnout we used Maslach's 22-item Burnout Inventory (MBI). It is the well-studied measurement
of burnout in the literature. MBI assesses emotional exhaustion, depersonalization and the lack of personal achievement. Study
sample included 60 registered and practicing mental health nurses, sample was divided in 2 groups - one who were provided with
group and individual supervision (n=30), and the second - control group (n=30). The experimental group received 8 sessions of
supervision. The levels of burnout were assessed 2 times for each nurse - before and after supervision sessions. The data show that
there is a statistically significant difference between emotional exhaustion and depersonalization indicators within experimental
group participants before and after the supervisions as well as between experimental group and control group indicators after
supervisions. Supervisions reduced burnout indicators in experimental group compared to control group. Supervision also was
helpful for nurses to understand better themselves, their emotions and behavioral aspects of the various work issues.
©
2015 The Authors. Published by Elsevier Ltd.
2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (Peerhttp://creativecommons-
reviewunderresp.org/licenses/bynsibilityofAcademic-nc-nd/4.0/World). Research and Education Center.
Peer-review under responsibility of Academic World Research and Education Center.
Keywords: Clinical supervision; nurse; burnout.
- Kristaps Circenis. Tel.: +371 67061528

E-mail address: Kristaps.Circenis@rsu.lv
1877-0428 © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of Academic World Research and Education Center.
doi:10.1016/j.sbspro.2015.09.023
Kristaps Circenis et al. / Procedia - Social and Behavioral Sciences 205 (2015) 86 – 91 87
1. Introduction
Nurses at work are facing many distress situations daily, they often work more than one workload, and are
constantly under emotional tension, physical and mental fatigue (Circenis, Millere, 2011). The most frequently
mentioned stress factors for nurses in study performed in Latvia were "risk of infection", "Inadequate remuneration
for work", "Emotionally intensive work with people", "Large (inadequate) amount of work" and "Intensive work"
(Circenis, Millere, 2012). Typical psychosocial issues for nurses are the burnout syndrome and compassion fatigue,
as well as anxiety and depression.
Burnout, as a form of work-related strain, is the result of a significant accumulation of work-related stress.
Maslach (1982) defined burnout as “a syndrome of emotional exhaustion, depersonalization, and reduced personal
accomplishment that can occur among individuals who do ‘people work’ of some kind” (Halbesleben, Buckley,
2004). Burnout is often construed as the result of a period of expending too much effort at work while having too
little recovery (Embriaco et al., 2007). Clinical symptoms of burnout are nonspecific and include tiredness,
headaches, eating problems, insomnia, irritability, emotional instability, and rigidity in relationships with other
people (Embriaco et al., 2007). During the last decade, much of the research on the antecedents of burnout has
continued to focus on work context/environmental factors as the proximal cause of burnout (Halbesleben, Buckley,
2004).
The burnout syndrome is mentioned as one of the main health issues concerning work among the professionals in
health-care (Hochwalder, 2007). Burnout may lead to a state which leaves negative effect on the quality of
professional actions and on the physical and emotional life of a nurse himself/herself (Tselebis, Moulou, & Ilias,
2001). Due to compassion fatigue and burnout, nurses` work may become less productive; employees are absent due
to illness, as well as the fluctuation of staff increases (Demir, Ulusoy, & Ulusoy, 2003; Najjar, Davis, Beck-Coon, &
Doebbeling, 2009). Several authors (Kravits McAllister-Black, Grant, & Kirk, 2010) consider that a high stress level
and burnout are considered to be serious reasons why nurses sometimes want to change work in which the stress
level is much lower. Burnout syndrome may be considered a marker of the health of the caregiver team (Embriaco et
al., 2007). Employees who are emotionally exhausted typically feel as though they lack adaptive resources and
cannot give any more to their job. The energy that they once had to devote to their work is now depleted, leaving
them without the resources to perform their work (Halbesleben, Buckley, 2004).
Decreasing work – related burnouts will not only positively influence the people working in the same sector, but
also decrease the expenses and offer economical benefit to organizations because the work absence and illnesses, as
well as the fluctuation of staff decrease (Awa, Plaumann, & Walter, 2010). Despite the pervasive nature of burnout
as an organizational problem, there has been relatively little research dedicated to presenting and, particularly,
evaluating interventions designed to reduce burnout since such a need was noted (Halbesleben, Buckley, 2004).
Evidence found in the literature (Awa et al., 2010) demonstrates that employees, who are present in prevention
programs, have less symptoms of distress than those who do not participate. The clinical supervision, as one of the
preventive measures (Platt Koch, 1986), is focused to expand the knowledge of a practicing professional; it helps to
improve clinical skills, helps to develop autonomy and self actualization as a professional. Feeling supported by the
supervisor and having a positive attitude towards clinical supervision may lead to lower levels of burnout for
depersonalization (Brunero, Stein̻Parbury, 2007).
Supervision can be a very important part of taking care of oneself, staying open to new learning; and is an
indispensable part of the helper’s wellbeing, ongoing self-development, self-awareness and commitment to
development (Hawkins, Shohet, 2006). Originally developed within the mental health care context and traditional
psychotherapies, clinical supervision is now being implemented for nurses in other clinical contexts. Clinical
supervision is a process of professional support and learning in which nurses are assisted in developing their practice
through regular discussion time with experienced and knowledgeable colleagues. Clinical supervision enables nurses
to discuss patient care in a safe, supportive environment (Brunero, Stein̻Parbury, 2007). Over the past decade, there
has been a deluge of research on the role that social support plays in the etiology of burnout. Studies have been
conducted investigating the effect of support from supervisors, coworkers, friends and family, organizations, unions,
and others (Halbesleben, Buckley, 2004).
Considerable evidence for supervision in nursing exists in the literature around the three core domains of Proctors
model of clinical supervision and there is sufficient empirical argument for clinical supervision to be implemented in
88 Kristaps Circenis et al. / Procedia - Social and Behavioral Sciences 205 (2015) 86 – 91
nursing (Brunero, Stein ̻ Parbury, 2007). Proctor in 1988 describes the main processes in the supervision of
counselling, for which she uses the terms formative, restorative and normative (Hawkins, Shohet, 2006). Formative
function, an educative activity which was the original basis for clinical supervision, normative function in the sense
that clinical supervision enables the development of consistency of approach to patient care (follows standards of
practice), restorative function, which promotes validation and support for colleagues through peer feedback.
Although presented as separate, the functions overlap and intersect in practice (Brunero, Stein-Parbury, 2007).
Up to now, in Latvia, there has been little research done to explore supervision influence to nurses' burnout. From
the previous study (Circenis, Millere, 2012) is known that the nurses' knowledge and experience about clinical
supervision in Latvia is very low - 59,8% of surveyed nurses never heard about supervisions, 95,5% did not attend
supervisions for nurses in past 5 years. Most of nurses (93,4%) participating in this study considered that the
practicing nurses need the supervisions.
2. Objective
Purpose of study was to evaluate the effectiveness of supervision of nurses practicing in mental health hospital in
Latvia aimed at preventing burnout.
3. Methods
Research performed using quantitative method. Study sample included 60 registered and practicing mental health
nurses, sample was divided in 2 groups - one who were provided with group and individual supervision (n=30), and
the second - control group (n=30). The experimental group received 8 sessions of supervision. The levels of burnout
were assessed 2 times for each nurse - before and after supervision sessions.
The Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1986) was used to measure burnout in this study.
The Inventory consists of 22 items phrased as statements about personal feelings and attitudes that are selfscored on
a seven-point frequency scale, ranging from 0 (never) to 6 (every day). The three subscales of the MBI include
emotional exhaustion, depersonalisation, and personal accomplishment. High scores on exhaustion and cynicism
and low scores on professional efficacy are indicative of burnout. We used the Human Services Survey variant,
which was translated in Latvian and adapted by Sanita Aispure in 2002. Each participant also full filled
demographic questionnaire and survey about satisfaction after attending supervisions.
Data collection procedures were in accordance with ethical principles (in accordance with the Declaration of
Helsinki), guaranteeing anonymity and confidentiality of respondents. This study received permission and
acceptance from Ethics committee of the Rīga Stradins University.
The data processing was performed using the Microsoft Excel and SPSS 22.0 statistical software. The
Kolmogorov–Smirnov test was used to establish normality of the data. The differences between MBI subscales
results were analyzed using a paired Student's t test for normally distributed data or the Wilcoxon ranked-sum test
for nonparametric distribution while analyzed data within one group results. The differences between MBI subscales
results were analyzed using non-paired Student's t test for normally distributed data or the Mann-Whitney U test for
nonparametric distributed data when compared results between groups. Significance was accepted at P<0.05 and all
values are expressed as mean ± standard deviation for parametric data or median (25 percentile; 75 percentile) for
nonparametric data.
4. Results
Total amount of 60 registered and practicing mental health nurses as respondents took part in the study. Age
range of respondents from 28 till 69 years (M=43.00; SD=10.07), average for practicing in nursing 21.00 year
(SD=11.77). Sample was divided in 2 groups - one (A) who were provided with group and individual supervision
(n=30), and the second (B) - control group (n=30). Participating nurses applied for supervisions and attended them
voluntarily. The characterization of both groups is shown in Table1.
Table 1. Characterization of nurses group who were attending supervisions (A) and control group (B)
Parameter Group A (n=30) Group B (n=30)
Age (years, M±SD) 45.03±7.61 47.63±12.03
Work experience (years, M±SD) 19.87±9.13 25.87±13.39
Bachelor degree level education (%) 47 43
The experimental group received 8 sessions of supervision during 3 month period. The MBI was used 2 times for
each nurse - before and after supervision sessions. Descriptive statistical parameters for Maslach Burnot Inventory
for both groups by subscales are shown in Table 2. Statistically significant differences could be found in all three
subscales between groups' means in first measurement (before supervisions), respectively - nurses groups' who
choose to attend the supervisions results indicate more profound burnout.
Table 2. Descriptive statistic parameters and comparison of Maslach Burnot Inventory of nurses group who were attending
supervisions (A) and control group (B)
Subscale Group A (n=30) Group B (n=30) P value
M±SD M±SD
Before MBI emotional exhaustion subscale 24.07±11.08 10.27±8.24 <0.001
supervisions
MBI depersonalization subscale 5.43±5.16 2.20±3.72 0.006
MBI reduced sense of personal accomplishment subscale 29.80±8.79 36.97±8.50 0.002
After MBI emotional exhaustion subscale 16.60±8.34 15.63±9.38 0.662
supervisions
Descriptive statistical parameters for Maslach Burnot Inventory within both groups by subscales are shown in
Table 3. Statistically significant differences could be found in all three subscales within group A means between
first (before supervisions) and second (after supervision) measurement.
Table 3. Descriptive statistic parameters and comparison of Maslach Burnot Inventory within groups A and B
Subscale Before After P value
supervisions supervisions
M±SD M±SD
Group A MBI emotional exhaustion subscale 24.07±11.08 16.60±8.34 <0.001
(n=30)
MBI depersonalization subscale 5.43±5.16 3.03±2.94 <0.001
MBI reduced sense of personal accomplishment subscale 29.80±8.79 37.23±5.02 <0.001
Group B MBI emotional exhaustion subscale 10.27±8.24 15.63±9.38 <0.001
(n=30)
90 Kristaps Circenis et al. / Procedia - Social and Behavioral Sciences 205 (2015) 86 – 91
5. Discussion
The main results of this study shows that there are statistically significant differences in all three MBI subscales -
emotional exhaustion, depersonalization, and reduced sense of personal accomplishment, within groups' who
attended supervisions means between first (before supervisions) and second (after supervision) measurement. Those
results approve that support services like supervision and counseling could be helpful to reduce burnout of nurses in
all three dimensions.
One hundred and sixty-six community mental health nurses in Wales, UK, had experienced six or more sessions
of clinical supervision and had completed the Maslach Burnout Inventory. Findings from this study suggest that if
clinical supervision is effective then community mental health nurses are likely to report lower levels of emotional
exhaustion and depersonalization (Edwards et al., 2006).
Emotional support can be obtained through clinical supervision that provides both formal and informal systems
for nurses to explore, discover, and examine their practice in a safe and supportive environment. This process of
emotional support may increase quality of patient care and job satisfaction, as well as reduce staff turnover by
decreasing ethical distress and burnout (Bland, Rossen, 2005).
According to our previous study (Circenis et al., 2011) that statistically significant correlations exists between
burnout and anxiety, depression and compassion fatigue among surgical care nurses, as well as Sabo considers that
there is a correlation between burnout and exhaustion due to compassion; nurses who have developed burnout have
a higher risk to develop compassion fatigue (Sabo, 2006), we can suggest that supervision could be helpful also for
decreasing anxiety, depression and compassion fatigue among nurses, meanwhile for confirming such suggestion the
further studies should be performed.
The nursing literature about use of supervision dominates with specialty groups such as mental health nurses and
aged care nurses, meanwhile we suggest that supervision could be helpful for different areas of nursing profession.
Study limitations: This study has such limitations as relatively small number of participants and convenience
sample, nurses applied for supervisions and attended them voluntarily.
6. Conclusions
The data show that there is a statistically significant difference between emotional exhaustion and
depersonalization indicators within experimental group participants before and after the supervisions as well as
between experimental group and control group indicators after supervisions. Supervisions reduced burnout
indicators in experimental group compared to control group. Supervision also was helpful for nurses to understand
better themselves, their emotions and behavioural aspects of the various work issues.
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Nurse Education in Practice 13 (2013) 506e511
Contents lists available at SciVerse ScienceDirect
Nurse Education in Practice

journalhomepage:www.elsevier.com/nepr
A clinical supervision model in bachelor nursing education  Purpose, content

and evaluation
Marie Louise Hall-Lord a, b, *, Kersti Theander a,1, Elsy Athlin a, 2
a Department of Nursing, Karlstad University, Universitetsgatan 2, SE 65188 Karlstad, Sweden
b
Department of Nursing, Gjøvik University College, Norway
article info abstract
Article history: Background: Collaboration between universities and clinical placements has been highlighted as a weak point of the nursing
Accepted 4 February 2013 education. To facilitate a good academic learning environment a clinical supervision model had been developed. The aim of
this study was to evaluate to what extent the goals of the model were met after one and a half years of utilisation.
Keywords:
Clinical practice Methods: A questionnaire was responded to by 30 head nurses, 12 main preceptors, 193 personal pre-ceptors, and 11 clinical
Evaluation nurse lecturers.
Nursing students
Results: Most of the participants perceived that the quality criteria in the model were met to a large extent, the students’
Supervision model
individual goals were achieved, and the supervision model contributed to fulfilment of goals, and assessment of the students.
The nurse lecturers scored highest and the personal preceptors lowest in most of the questions. The conditions stated in the
model were not always fulfilled. The de-ficiencies found were especially related to education level, time for supervision, and
support to the personal preceptors.
Conclusions: Despite some shortcomings the supervision model was considered by most participants as a valuable tool to be
used in an academic nursing education. Improvements of the model in regard to the findings were suggested.
2013 Elsevier Ltd. All rights reserved.
Background duties, often insufficiently prepared for the supervisor role and unaware of
educational goals (Landmark et al., 2003; Lambert and Glacken, 2005). Due
For many years the combination of theoretical and practical learning in to the heavy work-load of clinical nurses stu-dents often are left to themselves
nursing education has been highlighted as necessary in order to equip nursing in their clinical placements (Mc Carthy and Higgins, 2003; Brammer, 2005).
students adequately for their future role (Landers, 2000; Gillespie and
McFetridge, 2006). Many studies have reported problems to overcome in Reports about insufficient support to nursing students are frequent both
order to reach this pedagogic goal. After the transfer of nursing education to with regards to management of stressing and demanding events, such as
universities, the students’ time for learning in the clinical setting has encounters with severely ill or dying patients (Timmins and Kaliszer, 2002),
decreased in many Western countries, as has the nurse lecturers’ supervision and when it comes to using theory in practice and vice versa (Henderson et
of students in direct patient care. The lecturers’ role has changed from al., 2006). Studies have also indicated that nurse teachers’ and preceptors’
supervising students in ‘hands on nursing’ to focussing more on nursing experience and competence in reflection is low (O’Donovan, 2006). Chekol
theory and research (Humphreys et al., 2000; Barrett, 2007). The clinical (2003) concluded from her study in a Swedish university nursing college that,
supervision has to a great extent become a re-sponsibility of clinical nurses, despite being an academic education for 20 years, the clinical courses still
who are overwhelmed with patient were lacking in ‘academic variables’, such as active learning, reflection,
critical thinking, and research-oriented learning. The collaboration between
universities and clinical place-ments has repeatedly been highlighted as a
* Corresponding author. Department of Nursing, Karlstad University, Uni-versitetsgatan 2, weak point of the nursing education, where lack of communication and
SE 65188 Karlstad, Sweden. Tel.: þ46 547002420. agreement between parties involved in the students’ learning is described as a
E-mail addresses: marie-louise.hall-lord@kau.se, marie.hall-lord@hig.no (M.L. Hall- serious problem (Andrews et al., 2006; Gillespie and McFetridge, 2006).
Lord), kersti.theander@kau.se (K. Theander), elsy.athlin@kau.se (E. Athlin).
1 Tel.: þ46 547001930.

2
Tel.: þ46 54700 16 59.
1471-5953/$ e see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nepr.2013.02.006
M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511 507
As both the academic level and a good learning environment are of great assuring goal-directed collaboration over time between the university and
importance in professional nursing, the deficiencies found in the students’ the clinical placements
clinical studies are grave. Many attempts have been made during recent
decades in order to bridge over the obstacles found by means of supervision To reach these goals, a contract was drawn up between the Uni-versity
models (Lindgren et al., 2005; Andrews et al., 2006; Baxter, 2007; Häggman- and the County Council about the following quality criteria, which also were
Laitila et al., 2007). A factor highlighted in many models as important to clearly described in The Students’ Handbook:
successful su-pervision is the learning environment, which has been stressed
as imperative for the learning outcome (Chan, 2002; Papp et al., 2003). Other I. ‘Basic’ and ‘reference’ placements
factors of importance are the health care organisa-tion, workload,
collaboration, competence of the supervisors, and the superviseeesupervisor In order to create a good learning environment characterised by such
relationship (Andrews et al., 2006; Baxter, 2007). factors as wholeness, continuity, time, and trust in the studentepreceptor
relationship, the student was provided a ‘basic placement’ with a duration of at
least five weeks. In addition, op-portunities for shorter auscultations in
In Sweden as in other countries, the expectation of nursing education is to ‘reference’ wards or clinics were made available according to the students’
assure that bachelor nursing students have the appropriate knowledge and learning needs. A combination of these two types of placements was expected
skills needed for the nursing profession after completing their studies. This to provide a good opportunity for deep and comprehensive learning.
means that the goal of the nursing education not only includes adequate
nursing skills, but also competence in critical thinking, problem solving,
communi-cation, leadership, and utilisation of research in practice (The II. Four supervision levels were established to safeguard the quality of the
National Board of Health and Welfare, 2005). Since 1996 The Swedish students’ cognitive and affective learning, where continuous
National Agency for Higher Education has performed na-tional audits of the collaboration between the different levels of supervisors was the
bachelor nursing programmes showing that in many Swedish universities foundation. The following competence criteria for supervisors at
these requirements have not been suf-ficiently met (The Swedish National different levels were stated:
Agency for Higher Education, 2000). Inspired by these results a systematic Level A: Personal preceptors. Registered nurse (RN) in the clinical
checking-up of stu-dents’ clinical placements was done during 1999 at a placement with nursing experience of at least two years.
university in the central Sweden (Björkström et al., 1999). Many deficiencies Level B: Main preceptors. RN in the clinical placement with nursing
with regard to academic learning were revealed. Due to a high workload the experience of at least two years, post-basic nursing courses of at
clinical nurses were often lacking time for a profes-sional patient care. They least 15 ECTS, and a clinical super-vision course of 7.5 ECTS.
also lacked time for planning of their daily work, and for collegial reflections.
No time was scheduled for su-pervision of students. Collaboration with Level C: Clinical nurse lecturers (employed by the university). RN, several
faculty members often intruded on patient care, and added to the workload of years of nursing experiences, Master’s degree in Nursing or Health
colleagues. Most nurses were lacking experience and knowledge about peda- teaching methods, and a pedagogic course of 15 ECTS.
gogic methods of active learning, and utilisation of research find-ings in
clinical work. Deficiencies regarding the collaboration between the nursing Level D: Senior clinical nurse lecturer (employed by the university).
academy and the clinical field were found. Formal agreements were indistinct RN, PhD, and a pedagogic course of 15 ECTS.
and vague about organisation, goals, structure, and budget for the joint
responsibility to educate future nurses. The transition of the nursing education The personal preceptors were responsible for the daily supervi-sion in
to the uni-versity level was found to be not fully accepted by staff nurses and bed-side nursing, supporting the students in practical nursing skills. They
nurse leaders (Björkström et al., 1999). were expected to ensure that the students encountered such situations that
were needed to fulfil the learning goals, stimulate them to reflect upon their
experiences in the daily care, and assess their performance. The main
preceptors mainly provided support to groups of students with regards to
learning goals, supported personal preceptors in their role in the daily work
and in different formal meetings, and took part in assessments of students.
Development of a clinical supervision model The clinical nurse lecturers were the link between the university and the
clinical placement, served as a pedagogic resource by providing theoretical
After this checking-up a collaborative project was established in 2002 and emotional support to stu-dents and preceptors. The senior clinical nurse
between the University and the County Council. A county council in Sweden lecturer had the overall responsibility for the quality of the clinical education,
is a regional health service organisation with responsibility to provide care for and collaborated with and supported the clinical lecturers, arranged meetings
the inhabitants, in this region approximately 275 000 inhabitants. The County and workshops for the preceptors, and collaborated with authorities in regard
Council supplies clinical placements in the hospitals to students during to the supervision model.
clinical courses. The purpose with the collaborative project was to develop a
clinical supervision model which could reduce the deficiencies and facilitate a
good academic learning environment in the clinical education.
III. ‘Triangle meetings’
During the preparation phase of the project the following goals were set At the beginning and end of the clinical placement a ‘triangle meeting’
for the supervision model: was carried out between student, personal preceptor and clinical nurse lecturer
for goal-setting, planning and assessment of the students.
combining theory and practice
supporting students in active search for knowledge, critical thinking and
reflective learning IV. Academic assignments
supporting students’ affective learning
supporting clinical nurses in the preceptor role The learning in the clinical placement was supported by aca-demic
facilitating assessment of students assignments based on the goals of the clinical course. The
508 M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511
assignments were formulated to stimulate the students’ active learning, inspire persons (84%) responded to the questionnaire; 30 head nurses (88%), 12 main
them to extend their search for experience and knowledge, and to reflect upon preceptors (92%), 193 personal preceptors (82%), and 11 clinical nurse
their experiences in comparison with research findings. lecturers (100%).
Data analysis
IV. Clinical seminars
Data analyses with frequencies, percentages, means, and stan-dard
Clinical seminars were carried out in small groups of students (five to deviations were carried out using the Statistical Package for Social Sciences
seven) led by the clinical nurse lecturer and the main pre-ceptor. The aim of (SPSS Inc., Chicago, Illinois, USA, version 17.0).
these seminars was to integrate theoretical and practical knowledge by means
of reflection and critical thinking. The discussions in the seminar were based Ethical considerations
on the stu-dents’ academic assignments including both cognitive and affective
aspects. The personal preceptors were invited to participate in the seminars. The study was conducted in accordance with the ethical guidelines for
nursing research in the Nordic countries (Northern Nurses Federation, 2003).
Permission was obtained from leaders in the health-care sectors, where
placements for the nursing stu-dents were provided, and from the Head of the
V. Time for supervision Nursing programme at the University. The participants’ contribution in the
study was voluntary and all data were treated with confidentiality.
Protected time for the preceptors was stated in the contract between the
University and the County Council. This meant that at least 4 h/week/student
for the ‘personal preceptor’, and 8 h/week/ group of students (5e7 Results
students/group) for the ‘main preceptor’ should be used for student
supervision. The financing of these provisions was covered by the university. The characteristics of the respondents are described in Table 1. Most of
the respondents were women. Only five percent of the personal preceptors and
23% of the head nurses were men.
The study Many of the respondents had received their registration as nurses before
the transfer of nursing education to university level. Personal preceptors were
This supervision model was put into practice at five hospitals in all the youngest and had fewer years of experience after their nursing education
placements used for students’ training, with the exception of psychiatric care. than the other groups. Nurse lecturers were the oldest and had most years of
After one and a half years of utilisation, the present study was carried out experience since completing their nursing education.
aimed at evaluating to what extent the goals of the model were met.
Twenty-eight percent of the personal preceptors had a specialist
education, 30% had short post-basic nursing courses, four percent had
Methods postgraduate nursing courses, and 39% had a supervision course. More than
half of the main preceptors had a specialisation in nursing.
Design
Fifty percent of the main preceptors had short post-basic cour-ses, 50%
The study had a descriptive cross-sectional design using four study- postgraduate courses, and 75% a supervision course. All the nurse lecturers
specific questionnaires. had a specialist nursing education and postgraduate courses in nursing. Nine
of them had a Master’s degree in nursing or Health teaching methods. Seventy
Questionnaires percent of the head nurses had a specialisation in nursing, 43% had short post-
basic nursing courses, and only three percent postgraduate courses in nursing.
The questionnaires were constructed by two of the authors (EA
& MLHL) in close collaboration with the nursing director in the County The mean scores in Table 2 showed that the quality criteria in the model
Council. The content of the different questionnaires were mainly the same but were met to a large extent according to the respondents. The nurse lecturers
slightly changed to fit the four groups of participants. The questionnaires scored highest and the personal preceptors lowest regarding students’
covered background data (7 questions), questions about quality criteria related opportunity for active learning,
to learning and supervision (14 questions), factors contributing to assessment
and fulfilment of students’ goals (7 questions), collaboration and sup-port (6
questions). The questions had four or six response options: from disagree Table 1
Characteristics of the respondents.
completely (1) to agree completely (4), or six response alternatives: from
never (1) to always (6). One response option was graded yes, partly, and no. Personal Main Clinical Head
The questionnaires were scrutinised in the collaboration group (EA, MLHL preceptors preceptors lecturers nurses
and the nursing director), and discussed with clinical nurse lecturers before n ¼ 193 n ¼ 12 n ¼ 11 n ¼ 30
agreement about final versions. Sex n (%)
Women 183 (95) 12 (100) 11 (100) 23 (77)
Men 10 (5) 0 0 7 (23)
Age m (SD) 42 (9.7) 46 (9.5) 50 (7.8) 49 (7.2)
Years since nursing 14 (10.8) 21 (12.5) 28 (6.7) 23 (8.9)
Informants and procedure education m (SD)
Specialist nursing n (%) 65 (34) 8 (67) 11 (100) 21 (70)
Post basic nursing 58 (30) 6 (50) e 13 (43)
The questionnaire with an information letter was distributed to 294 courses n (%)
persons: 34 head nurses, 13 main preceptors, 236 personal preceptors, and 11 Postgraduate nursing 7 (4) 6 (50) 11 (100) 1 (3)
clinical nurse lecturers. Inclusion criteria were that the head nurses and courses n (%)
preceptors worked in somatic care and at the wards during the project period. Supervision 76 (39) 9 (75) e e
course n (%)
After one reminder 246
opportunity for learning in reference placements, and combination of theory studies where both clinical nurses and nurse lecturers are used as respondents
and practice. The personal preceptors supervised the students in learning, by (Athlin et al., 2012), the nurse lecturers in general reported a slightly more
means of reflection, to a greater extent than what the main preceptors did. positive attitude to the model than the clinical nurses. Deficiencies in
Personal preceptors used evidence-based research more seldom in their work academic level of the clinical edu-cation led to the development of the
as nurses than the main preceptors did. The nurse lecturers reported that they supervision model. Nurse lecturers are probably more concerned about this
used evidence-based research in clinical seminars to a large extent. Personal than clinical nurses, which may have biased the nurse lecturers’ attitudes.
preceptors rarely obtained the prescribed time (4 h/week/ student) for the
supervisor function, while the main preceptors could use their time (8 The idea of four supervision levels in this model was meant to
h/week/group of students) more often. Personal preceptors participated compensate for the fact that many clinical nurses who are assigned to students
frequently in triangle meetings, but less often in clinical seminars, in which as preceptors are lacking academic competence in nursing (Mc Carthy and
the main preceptors very often took part. The head nurses considered that the Murphy, 2010; Borch et al., 2012). Our study revealed that the personal
pre-ceptors could use the prescribed time for supervision to a higher degree preceptors had many years of nursing experiences, but most of them lacked
than did the preceptors. The head nurses scored higher than the personal specialisation, as well as ac-ademic and pedagogic courses. The main
preceptors concerning their participation in clinical seminars. All respondents preceptors and clinical lecturers were considered to be the more experienced
agreed to a great extent that the infor-mation given from the nursing college and more highly educated nurses, who should provide support and knowl-
about the nursing education was sufficient. edge, both to students and personal preceptors. Our findings showed that these
expectations were only partly met, as half of the main preceptors were lacking
post-graduate courses, and one quarter lacked a pedagogic course. This was
both remarkable and discouraging, since the competence of the main
The respondents’ perception of factors contributing to assess-ment of preceptors was stated to be at post-graduate level together with a supervision
students and to students’ fulfilment of goals are presented in Table 3. All course. This must be seen as a great failure, since this group of preceptors was
groups of respondents perceived that they could contribute to the students’ expected to bridge over the lack of academic and pedagogic competence of
fulfilment of goals to a large extent, where the personal preceptors scored the personal preceptors in the daily care. The most probable reason for the
highest. The main preceptors and the clinical lecturers perceived to a large low competence of the main preceptors is that there are still too few clinical
extent that the tri-angle meetings and the clinical seminars contributed to the nurses with higher education working in clinical practice (Josefsson et al.,
assessment of students. The study guide and academic assignments were 2007; Gardulf et al., 2008).
considered to contribute.
Furthermore, the respondents perceived to a large extent that the students’

individual goals were achieved, and the supervision model contributed to Notable was that two of the clinical nurse lecturers were lacking in formal
fulfilment of goals. In all these items the personal preceptors scored lowest. qualifications, which indicates difficulties in recruitment of academically
competent nurses also in the university (Smith and Crookes, 2011).
The respondents’ perceptions of collaboration and support are presented in
Table 4. It was interesting that the personal preceptors scored higher than both the
The collaboration between and support from clinical lecturers, main main preceptors and the nurse lecturers regarding their own contribution to
preceptors and personal preceptors was perceived as well- or rather well- the students’ fulfilment of goals. They scored higher than the main preceptors
functioning. The clinical lectures and main preceptors scored highest in these regarding their opportunity to support students in learning by reflection. This
items. The collaboration between the uni-versity and clinical practice was conviction among preceptors of being very important for nursing students is
scored higher by nurse lecturers and main preceptors than by personal found elsewhere, and may be understood as a consequence of their
preceptors and head nurses. commitment to their role (Danielsson et al., 2009; Courthney-Pratt et al.,
2012). However, as personal preceptors are often lacking both academic and
Discussion pedagogic competence, the risk is that they only take the practical aspects of
nursing in consideration in their supervi-sion, and focus merely on practical
The findings indicated that the supervision model evaluated in this study issues in their reflection together with the students. If so, there is a risk that
could contribute to the fulfilment of goals for the clinical nursing education these pre-ceptors with low academic and pedagogic competence may serve
and to the assessment of students. There was a high agreement among all
groups of participants, but as in other
Table 2
The respondents’ perceptions of to what extent the quality criteria in the model were met.
Personal preceptors Main preceptors Clinical lecturers Head nurses

n ¼ 193 m (SD) n ¼ 12 m (SD) n ¼ 11 m (SD) n ¼ 30 m (SD)
Opportunity of reference placements (1e6)a 4.6 (0.9) 4.9 (0.9) 5.2 (0.9) e
Opportunity of active learning (1e6)a 4.5 (0.9) 4.7 (0.7) 5.0 (0.9) e
Supervision by means of reflection (1e4)b 3.6 (0.7) 2.7 (0.8) 3.5 (0.5) e
Combining theory and practice (1e6)a 4.6 (0.7) 4.8 (0.5) 4.6 (0.9) e
Personal preceptors e 4 h/week for supervision (1e6)a 3.0 (1.4) e e 4.1 (1.5)
Personal preceptors’ participation in triangle meetings (1e6)a 5.3 (1.1) e 5.6 (0.7) 5.3 (1.2)
Personal preceptors’ participation in clinical seminars (1e6)a 1.7 (1.2) e 2.3 (1.0) 3.9 (1.6)
Main preceptors e 8 h/week for supervision (1e6)a e 4.8 (1.6) e 5.1 (1,3)
Main preceptors’ participation in clinical seminars (1e6)c e 5.3 (1.0) 5.7 (0.5) e
Utilization of evidence-based research (1e6)a 3.0 (1.2) 4.1 (0.8) 4.5 (1.4) e
Information about the education (1e4)c 3.0 (0.8) 3.3 (0.5) e 3.1 (0.5)
a Scores could range from 1 (never) to 6 (always).
b
Scores could range from 1 (always) to 4 (never).
c
Scores could range from 1 (disagree completely) to 4 (agree completely).
510 M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511
Table 3
The respondents’ perceptions of factors contributing to assessment of students and students’ fulfilment of goals.
Personal preceptors Main preceptors Clinical lecturers

n ¼ 193 m (SD) n ¼ 12 m (SD) n ¼ 11 m (SD)
Triangle meetings contributed to assessment (1e6)a 4.4 (1.1) 5.0 (0.7) 5.1 (1.2)
Clinical seminars contributed to assessment (1e6)a e 4.8 (1.3) 5.3 (0.8)
Study guide contributed to fulfilment of goals (1e6)a 4.4 (0.7) 4.8 (0.5) 4.7 (0.7)
School assignments contributed to fulfilment of goals (1e6)a 4.3 (0.7) 4.4 (0.7) 4.6 (0.7)
Respondent contributed to fulfilment of goals (1e6)a 4.5 (0.6) 4.0 (1.0) 4.4 (0.7)
The students’ fulfilment of the goals of the clinical courses (1e6)a 4.5 (0.69) 4.8 (0.6) 4.9 (0.5)
Supervision model contributed to students’ fulfilment of goals (1e3)b 2.3 (0.6) 2.6 (0.5) 2.8 (0.4)
a Scores could range from 1 (never) to 6 (always).
b Scores could range from 1 (no) to 3 (yes).
as a conserving factor in nursing, instead of being proactive in their emotional support to nurses in their preceptor role was a driving force, when
supervision and role-modelling (Allan et al., 2011). The main pre-ceptors this supervision model was devised, and it still is (Williams and Irvine, 2009;
rather low scores concerning support to students in reflection highlight what Omansky, 2010). The support from nurse lecturers to main preceptors was
other studies have already shown (Braine, 2009; Duffy, 2009), namely that mostly reported as working well, which may be understood as a consequence
preceptors need further training in this area. of their time together in clinical seminars and frequent collaboration
concerning students’ clinical studies.
The personal preceptors scored somewhat lower than both the main
preceptors and nurse lecturers concerning utilisation of research findings in Our study illuminated the need of improvement of the super-vision model.
their daily work and participation in clinical seminars. This is easily The findings indicated that one way could be to extend the main preceptor
understood in light of both their lower ac-ademic education, and what we role, in line with previous trials using so-called clinical facilitators
know about nurses’ heavy work-load in general. Even if they were invited to (Henderson et al., 2009) or link-teachers (Williams and Taylor, 2008) with a
the clinical seminars, they did not have time reserved for these seminars as clear super-numerous status. The present study showed that the main pre-
the main preceptors had. Our findings showed that despite the agreement that ceptors’ protected time of 8 h/week/group of students mostly could be used.
time should be set aside for supervision of students, this was not always As they also had higher academic and pedagogic compe-tence than the
fulfilled especially for the personal preceptors. It was interesting that the head personal preceptors, they would better contribute to the goals that were set in
nurses in the wards scored higher with regards to the opportunity for the the nursing education. The personal preceptor role could be replaced with
preceptors to get the time agreed upon for supervision. As also nurse leaders ‘daily supervisors’; nurses responsible for patients assigned to nursing
are very busy during their working days (Johansson et al., 2010), it may be students on each shift basis. The expectation on these nurses would mainly be
assumed that the head nurses thought that the contract was followed, but in to super-vise students in clinical skills together with the inevitable and
reality many preceptors had not been able to use all their ‘protected time’ for important role-modelling (Perry, 2009).
supervising students. This lack of time in the preceptor role, which has been
reported in many years (Mc Carthy and Murphy, 2010), must be stressed as
an important issue to focus upon in further development of student
supervision. Methodological considerations
Some important limitations must be addressed. The sample used,

Our study confirms what has been stressed in other previous studies comprised the total population with few participants in some of the groups,
(Andrew et al., 2009; Hallin and Danielsson, 2009; Saarikoski et al., 2009) but the response rate was satisfying in all groups, which strengthened the
that collaboration and partnership between nursing institution and nursing validity of the findings (Polit and Beck, 2008).
practice is of utmost importance for students’ learning in the clinical
placements. Collaboration be-tween the different supervision levels in our Nursing students should have been included in the question-naire survey.
supervision model was meant to be the foundation and ‘binder’, in order to Their opinions and experience about the supervision model would have
improve the students’ learning in the placements (Barnett et al., 2010). Our provided additional understanding about the pros and cons of the model.
findings showed that this mostly functioned well or rather well between the However, in addition to current study, ten nursing students in clinical
parties involved. However, the support to personal preceptors was reported as placements during the same period were interviewed about their experiences
less satisfactory. Many personal pre-ceptors considered that they did not get of the supervision model, its impact on their clinical learning, and the
sufficient support from main preceptors and clinical lecturers. This finding supervision they had received.
must be regar-ded as a serious flaw, since the need of both pedagogic and
The findings, which accorded well with the findings of this study, are
reported elsewhere (Hall-Lord and Athlin, 2005).
Table 4
The respondents’ perceptions of support and collaboration.
Personal preceptors Main preceptors Clinical lecturers Head nurses

n ¼ 193 m (SD) n ¼ 12 m (SD) n ¼ 11 m (SD) n ¼ 30 m (SD)
Support from nurse lecturer (1e4)a 2.8 (1.0) 3.8 (0.5) e e
Support from main preceptor (1e4)a 2.9 (1.1) e e e
Collaboration with nurse lecturer (1e4)a 3.3 (0.8) 3.8 (0.4) e 3.3 (0.6)
Collaboration with main preceptor (1e4)a 3.2 (1.0) e 3.9 (0.3) 3.5 (0.8)
Collaboration with preceptors (1e4)a e 3.3 (0.6) 3.6 (0.5) e
Collaboration between university and clinical practice (1e4)a 2.7 (0.7) 3.0 (0.7) 3.3 (0.7) 2.8 (0.7)
a Scores could range from 1 (disagree completely) to 4 (agree completely).
Conclusions Hallin, K., Danielsson, E., 2009. Being a personal preceptor for nursing students: registered
nurses’ experiences before and after introduction of a preceptor model. Journal of Advanced
Nursing 65, 161e174.
The supervision model evaluated was considered by a majority of Hall-Lord, M.L., Athlin, E., 2005. Utvärdering av avtal gällande den verksamhets-förlagda
participants, to be a useful tool for clinical supervision of stu-dents in an utbildningen i sjuksköterskeprogrammet e med fokus på handle-dningsmodellen
academic nursing education. However, the conditions stated in the model (Evaluation of Agreement Concerning the Clinical Education in the Nursing Programme e
Focused on the Supervision Model). Report. Karlstad University, Karlstad (in Swedish).
were not always fulfilled, despite the agree-ment between the University and
the County Council, responsible for the students’ placements. The deficiencies Henderson, A., Fox, R., Malko-Nyhan, K., 2006. An evaluation of preceptors’ per-ceptions of
found were espe-cially related to education level, time for supervision, educational preparation and organizational support for their role. Journal of Continuing
Education in Nursing 37, 130e136.
collaboration and support given to personal preceptors. Improvements of the Henderson, A., Twentyman, M., Eaton, E., Creedy, D., Stapleton, P., Lloyd, B., 2009.
model with regards to the findings were suggested. Creating supportive clinical learning environments: an intervention study.
Journal of Clinical Nursing 19, 177e182.
Humphreys, A., Gidman, J., Andrews, M., 2000. The nature and purpose of the role of the nurse
lecturer in practice settings. Nurse Education Today 20, 311e317.
Conflict of interest statement Häggman-Laitila, A., Eriksson, E., Meretoja, R., Sillanpää, K., Rekola, L., 2007. Nursing
students in clinical practice e developing a model for clinical supervision. Nurse Education
There are no conflicts of interest to declare. in Practice 7, 381e391.
Johansson, B., Fogelberg-Dahm, M., Wadensten, B., 2010. Evidence-based practice: the
importance of education and leadership. Journal of Nursing Management 18, 70e77.
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Available online at www.sciencedirect.com
ScienceDirect
Procedia - Social and Behavioral Sciences 112 (2014) 97 – 101
International Conference on Education & Educational Psychology 2013 (ICEEPSY 2013)
Clinical supervision: priority strategy to a better health

Sandra Cruza*, António Luís Carvalhoa, Paulino Sousaa
a
Escola Superior de Enfermagem do Porto, Rua Dr. António Bernardino de Almeida s/n, Porto 4200-072, Portugal
Abstract
We carried out a study with the aim to relate the implementation of a clinical supervision (CS) model with the supervised nurses’
answers to stress and the coping resources they use. 38 paired questionnaires with the Portuguese versions of the Manchester Clinical
© © © © ©
Supervision Scale (MCSS ) and the Brief Personal Survey (BPS ) were obtained. SPSS version 18.0 was used to treat data.
© ©
MCSS Cronbach’s alpha value for the total score was 0,938 and BPS’ was 0,60. Several correlations were found. Our study
pointed out that CS can optimize the nurses’ coping resources and help them to answer to stress.
© 20133 TheAuthors..PublishedbybyElsevierElsevierLtdLtd..
Selection andpeer-review-underresponsibilityof ofCognitiveDrZafer-counselling,Bekirogullariresearch. and conference services (c-crcs).
Keywords: Clinical supervision model in nursing; Stress; Coping; Manchester Clinical Supervision Scale©; Brief Personal Survey©
Introduction
The NHS (2011) refers the difficulty to assess clinical supervision and its effectiveness but they recognize
arguments on its capacity to decrease stress, prevent burnout and others benefits. So, we decided to carry out a
study which problem was: which is the relationship between the implementation of a clinical supervision model in
nursing and the nurses’ answers to stress and the coping resources they use? The aim of this study was to relate
the implementation of a clinical supervision model with the supervised nurses’ answers to stress and the coping
resources they use through the application of a questionnaire comprised by several parts such as the Portuguese
versions of the Manchester Clinical Supervision Scale© (MCSS©) and the Brief Personal Survey© (BPS©) and with this
paper we pretend to publicize the results of the study.
This paper is divided into three main sections: the first one is related to the methodology, in the second one we
presented the results and finally the discussion and the conclusion of it.
4. Corresponding author. Tel.: +351-22-5073500; fax: +351-22-

5096337. E-mail address: sandracruz@esenf.pt
1877-0428 © 2013 The Authors. Published by Elsevier Ltd.

Selection and peer-review under responsibility of Cognitive-counselling, research and conference services (c-crcs).
doi:10.1016/j.sbspro.2014.01.1143
98 Sandra Cruz et al. / Procedia - Social and Behavioral Sciences 112 (2014) 97 – 101
1. Methodology
We carried out an action research study which can be conceptualized as a problem solving activity and a
research activity (Marshall & McKay, 2006), although this paper is related to a small phase of the large research.
After several phases of the study, we implemented a clinical supervision model in nursing for six months in three
wards of a Hospital Centre in Portugal.
The population comprises all the individuals with common characteristics for the research. Therefore, our
participants, in this phase of the study, were all the supervised nurses (n=62) who have been under the
implemented model. The instrument used to collect data was a questionnaire divided into several parts such as
the Portuguese versions of the MCSS© and the BPS©. We had privileged personal contact with all supervised
nurses from the selected care units, allowing us the opportunity to explain the study, methodology, ground rules
to fill in the questionnaire and the periods for doing it. They answered the questionnaire twice (the second time
was after the implementation of the clinical supervision model and the supervised nurses were not allowed to
look at the first questionnaire when they were filling the second one).
The absence of instruments to evaluate clinical supervision in nursing made it difficult the development of it
in the nurses’ field (Cruz & Carvalho, 2012). The MCSS © was developed by Julie Winstanley (2000) in the
United Kingdom and tested in Australia (Hyrkäs, Appelqvist-Schmidlechner & Paunonen-Ilmonen, 2003; Cruz,
2011) and it “(…) evaluates the quality and effectiveness of the supervision provided and the supervisees’
opinion of the effect of clinical supervision in their professional development, improvement in skills, time for
reflection and the quality of the supervisory relationship” (Cruz, 2011).
This scale was used as an “(…) outcome measure in more than 80 clinical supervision evaluation studies, in
12 countries worldwide (…) (White & Winstanley, 2010, p. 153), and has been translated from English into
Swedish and Norwegian (Severinsson, 2012), Portuguese (Cruz, 2011; Cruz & Carvalho, 2012), Finnish
(Hyrkäs, Appelqvist-Schmidlechner & Paunonen-Ilmonen, 2003) and other languages.
Accordingly, the current version of the MCSS© is named the MCSS-26© (Winstanley & White, 2012, p. 950). In
the supervised nurses’ questionnaire we also used the Portuguese version of the BPS © (McIntyre; McIntyre
& Silvério, 1999). To fill the BPS©, it is requested to the participants to point ‘true’ or ‘false’ in each of the 99
statements of the instrument. Then the answers are compared with a matrix which allows the researcher to give a
value of 1 or 0 to each statement accordingly to what was stipulated by the author.
A paired sample with 38 filled out questionnaires was obtained from the supervised nurses. Statistical
Package for Social Sciences© (SPSS©) version 18.0 was used for data analysis.
We requested permission to use the Portuguese versions of the MCSS© and BPS© to the authors. For the
research, we obtained permission from the Centro Hospitalar do Médio Ave E.P.E. (Médio Ave Hospital
Centre). The questionnaire had an introductory part where we explained the study and the ethical issues we were
going to respect like the anonymity and confidentiality of the collected information. We also outlined the
voluntary nature of the nurses’ participation.
2. Results
After the implementation of a clinical supervision model in nursing in the selected wards, we requested to the
supervised nurses to answer a questionnaire comprised by several parts.
A total of 61 questionnaires were obtained with a MCSS© Cronbach’s alpha value for the total score of 0,938
and BPS© Cronbach’s alpha value for the total score of 0,60. The response rate was 98%. The relevant socio
demographic data are shown in table 1.
Sandra Cruz et al. / Procedia - Social and Behavioral Sciences 112 (2014) 97 – 101 99
Table 1. Socio demographic data
n=61 %
Sex
Female 55 90
Male 6 10
Professional Category
Nurse 48 79
Specialized Nurse 13 31
In our sample, 90% of the respondents were female and 79% had the professional category of nurse.
Appropriated statistical tests were used to assess the significant relations between the variables (table 2). We
highlighted that the paired questionnaires were 38.
Table 2. Correlation between the Portuguese Versions of the MCSS© and the BPS©
MCSS© Subscales
©
BPS
Difference
between the 2 Trust/ Supervisor Improved Importance/ Finding Personal
advice / Reflection Total
times of data rapport support care / skills value of CS time issues
collection
Philosophical SCC -0,012 0,087 0,052 0,021 -0,098 -0,019 -0,024 0,015
spirit p 0,946 0,624 0,768 0,904 0,582 0,916 0,894 0,934
SCC -0,163 -0,176 -0,028 -0,253 0,031 -0,007 -0,385* -0,196
Coping
p 0,350 0,311 0,871 0,143 0,862 0,970 0,023 0,260
SCC -0,229 -0,173 -0,116 -0,321 -0,006 -0,060 -0,371* -0,224
Denial
p 0,185 0,321 0,507 0,060 0,972 0,731 0,028 0,196
Distress and SCC 0,075 0,102 0,117 0,094 0,127 0,241 -0,029 0,174
Health p 0,668 0,562 0,504 0,590 0,468 0,164 0,870 0,318
SCC 0,176 0,155 0,071 0,081 0,089 0,032 0,229 0,167
Excessive Pressure
p 0,313 0,374 0,687 0,642 0,609 0,854 0,186 0,337
Anger/ SCC 0,189 0,207 0,144 0,355* 0,052 0,178 0,276 0,209
Frustration p 0,277 0,233 0,408 0,036 0,768 0,306 0,109 0,229
SCC 0,089 0,141 0,005 0,069 -0,028 0,126 -0,065 0,088
Anxiety
p 0,611 0,419 0,979 0,696 0,875 0,472 0,710 0,616
SCC 0,113 0,109 0,212 0,228 0,216 0,041 0,214 0,179
Depression
p 0,518 0,533 0,222 0,187 0,214 0,814 0,216 0,302
SCC -0,263 -0,250 -0,246 -0,344* 0,114 -0,242 -0,189 -0,256
Social Support
p 0,126 0,148 0,155 0,043 0,514 0,162 0,277 0,137
SCC 0,211 0,189 0,070 0,114 0,047 -0,098 0,128 0,185
Hostility
p 0,224 0,278 0,690 0,516 0,789 0,574 0,465 0,288
Physiological SCC 0,116 0,084 -0,043 -0,005 0,063 0,066 -0,039 0,065
Answer p 0,509 0,631 0,806 0,977 0,717 0,706 0,825 0,712
Dysphoric SCC 0,322 0,285 0,339* 0,412* 0,061 0,152 0,283 0,345*
Emotionality p 0,059 0,098 0,046 0,014 0,730 0,383 0,100 0,042
SCC 0,040 0,164 -0,011 0,173 0,179 -0,091 0,119 0,101
Ineffectiveness
p 0,821 0,345 0,950 0,320 0,303 0,604 0,496 0,563
SCC 0,100 0,182 0,261 0,125 0,125 0,152 0,281 0,271
Loss of Control
p 0,567 0,295 0,130 0,474 0,476 0,385 0,102 0,116
100 Sandra Cruz et al. / Procedia - Social and Behavioral Sciences 112 (2014) 97 – 101
SCC 0,162 0,056 0,187 -0,018 0,241 0,011 0,121 0,167

Guiltiness
p 0,353 0,750 0,281 0,917 0,164 0,952 0,488 0,338
SCC – Spearman Correlation Coefficient; *Significant Correlation, significance level of 5%.
From the analysis of table 2, we verified that there are several significant correlations such as moderate
correlation between the ‘dysphoric emotionality’ scale of the BPS© and the subscale of ‘importance/value of CS’
of the MCSS© (0,412) and we verified a weak correlation between:
 the ‘coping’ scale of the BPS© and the subscale of ‘reflection’ of the MCSS© (-0,385);
 the ‘denial’ scale of the BPS© and the subscale of ‘reflection’ of the MCSS© (-0,371);
 the ‘anger/frustration’ scale of the BPS© and the subscale of ‘importance/value of CS’ of the MCSS© (0,355);
 the ‘social support’ scale of the BPS© and the subscale of ‘importance/value of CS’ of the MCSS© (-0,344);
 the ‘dysphoric emotionality’ scale of the BPS© and the subscale of ‘improved care/skills of CS’ of the
MCSS© (0,339).

3. Discussion and conclusion
Nowadays, “(…) economic constraints, downsizing, restructuring, and the burden of emerging and remerging
diseases on healthcare systems have created stressful working environments for many providers” (Ulrich;
O’Donnel; Taylor; Farrar; Danis & Grady, 2007, p. 1709). Montes-Berges and Augusto (2007) state that “(…) as
stress affects a large number of nursing professionals and gives rise to different negative consequences, it is
necessary to pay attention to the resources or devices that nurses could use to diminish these effects” (p.163-
164). It is undeniable that nurses need support in their professional practice because their practice is much more
complex and unpredictable than what is said in the nursing theory. Through clinical supervision, nurses can
perform with expertise, improve and develop the quality of the care they provide to their clients, reduce stress
and optimize their coping resources.
The implementation of the clinical supervision model in nursing was for a short period of time (six months)
but even though, our study pointed out that when the supervised nurses felt more ‘anger/frustration’or
‘dysphoric emotionality’ (mood changes) greater was the ‘importance/value of CS’.
Teasdale and Brocklehurst and Thom (2001) refers in their study that the “Nursing in Context Questionnaire
detected some statistically significant differences with supervised nurses reporting a more listening and
supportive management, coping better at work and feeling that they had better access to support than
unsupervised nurses” (p. 216). Nielsen and Tulinius (2009) state that stress and burnout is major problem among
general practitioners. Therefore is necessary to be aware of the positive effects of CS in these variables and we
need to invest in all strategies that can reduce stress and improve coping. Our study pointed out that CS can
optimize the nurses’ coping resources, becoming, by this way, a priority strategy to a better health
simultaneously for the patients and for the supervised nurses.
Acknowledgements
We gratefully acknowledge Julie Winstanley (PhD, MSc, BSc, CStat, CSci - Director, Osman Consulting Pty
Ltd, Australia and Principal Research Fellow, Patricia Ritchie Centre for Cancer Care and Research, University
of Sydney, Australia) and to Edward White (PhD, MSc(SocPol), MSc(SocRes), RMN, DipCPN, PGCEA, RNT,
FACN, FACMHN - Director, Osman Consulting Pty Ltd, Conjoint Professor, School of Psychiatry, University
of New South Wales, Sydney, Australia) for their huge contribution.
Sandra Cruz et al. / Procedia - Social and Behavioral Sciences 112 (2014) 97 – 101 101
We gratefully acknowledge Teresa Mendonça McIntyre (PhD), author of the BPS © for her permission to use
it.
We also gratefully acknowledge the Centro Hospitalar do Médio Ave E.P.E. (Médio Ave Hospital Centre)
to allow the research and particularly for their precious collaboration with us, without their commitment and
support this research wouldn’t have been possible.
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KESIMPULAN
Berdasarkan penelitian mengenai pengaruh supervisi klinis terhadap penatalaksanaan
universal precaution oleh perawat (literature review) pelaksanaan supervisi klinis dimaksud
untuk membantu mengevaluasi tindakan keperawatan sehingga sesuai dengan standar. Hasil
ulasan literatur menunjukan bahwa supervisi klinis berpengaruh terhadap penerapan
universal precaution oleh perawat. sehingga keesimpulan yang didapatkan adalah bahwa
supervisi klinis amat berperan dalam tercapainya penerapan praktik keperawatan agar sesuai
dengan standar yang sudah ditetapkan, dalam hal ini adalah universal precaution guna
tercapainya budaya safety sehingga mencegah infeksi dan kecelakaan kerja bagi perawat.
Penerapan supervisi klinis juga di jelaskan dalam beberapa jurnal. Pertama, pada
jurnal Pengaruh Supervisi Metode Klinis Terhadap Kelengkapan Dokumentasi Asuhan
Keperawatan di RSUD H Soewondo Kendal yang menjelaskan bahwa supervisi metode klinik
dapat meningkatkan kelengkapan dokumentasi asuhan keperawatan. Hasil penelitian ini
menunjukkan terdapat pengaruh supervisi metode klinis terhadap kelengkapan dokumentasi.
Terlihat dari sebelum dilakukan supervisi metode klinis terdapat 26 dokumentasi askep
dengan kategori tidak lengkap dan setelah dilakukan supervisi metode klinis terdapat 25
dokumentasi askep dalam kategori lengkap.
Kedua, pada jurnal internasional Supervision in Nursing: Latvian sample study. Jurnal
ini menjelaskan supervise dapat mengurangi indikator kelelahan dalam kelompok eksperimen
dibandingkan dengan kelompok kontrol. Supervisi juga bermanfaat bagi perawat untuk
memahami diri mereka sendiri, emosi dan aspek perilaku mereka dari berbagai masalah
pekerjaan.
Ketiga, pada jurnal internasional mengenai A clinical supervision model in bachelor
nursing education  Purpose, content and evaluation. Jurnal ini menjelaskan bahwa Sebagian
besar peserta menganggap bahwa kriteria kualitas dalam model terpenuhi untuk sebagian
besar, tujuan individu siswa tercapai, dan model pengawasan berkontribusi terhadap
pemenuhan tujuan, dan penilaian siswa. Meskipun ada beberapa kekurangan, model
pengawasan dianggap oleh sebagian besar peserta sebagai alat yang berharga untuk digunakan
dalam pendidikan keperawatan akademis.
Keempat, pada jurnal internasional mengenai Clinical supervision: priority strategy to
a better health. Jurnal ini menjelaskan bahwa supervisi klinis (CS) dapat mengoptimalkan
sumber daya perawat mengatasi dan membantu mereka untuk menjawab stres.
Berdasarkan kelima jurnal tersebut dapat disimpulkan bahwa supervise klinis
merupakan metode yang baik dan benar serta sangat efektif dan efisien yang diterapkan
dilapangan.

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Jurnal Ilmu Keperawatan. Vol.II.No.2.

PENGARUH SUPERVISI KLINIS TERHADAP

Kata Kunci : Universal Precaution, Supervisi, Budaya Safety, Infeksi, Nosocomial

PENDAHULUAN yang meneliti tentang pengaruh supervisi

Ladany (eds.), Conselor Supervision: Grayson, L. et al. 2009. Hand Hygiene

Suarli, Suchri & Bachtiar, Yanyan. 2007.

Swanburg, R. C. 1990. Management and

Trinkoff, A. M. et al. 2007. Personal Safety for

World Health Organization. 2007. Guidelines on

Nunik Wahyu Lestari*), Erni Suprapti**). Achmad Solechan***)

Kata Kunci : Dokumentasi asuhan keperawatan dan supervisi metode klinis

Keywords: Documentation of nursing care and supervision of clinical methods

Pengaruh Supervisi Metode Klinis Terhadap Kelengkapan . . . (N. W. Lestari, 2014) 1

2 Jurnal Ilmu Kperawatan dan Kebidanan (JIKK)

Pengaruh Supervisi Metode Klinis Terhadap Kelengkapan . . . (N. W. Lestari, 2014) 3

4 Jurnal Ilmu Keperawatan dan Kebidanan (JIKK)

Pengaruh Supervisi Metode Klinis Terhadap Kelengkapan . . . (N. W. Lestari, 2014) 5

3. Kelengkapan Dokumentasi Asuhan Keperawatan Sebelum dan Sesudah Supervisi Metode

Berdasarkan Tabel.4 menunjukan sebagian mendapatkan supervisi metode klinis

6 Jurnal Ilmu Keperawatan dan Kebidanan (JIKK)

Pengaruh Supervisi Metode Klinis Terhadap Kelengkapan . . . (N. W. Lestari, 2014) 7

Kelengkapan dokumentasi asuhan

8 Jurnal Ilmu Keperawatan dan Kebidanan (JIKK)

Sunaryo. (2004). Psikologi untuk keperawatan. Jakarta: EGC

Pribadi, A. (2009). Analisis pengaruh

Lusianah. (2008). Hubungan motivasi dan

Pieter, HZ dan Lubis, NL. (2010). Pengantar

Samsualam, Indar, & Muh Safar. (2008).

6th World conference on Psychology Counseling and Guidance, 14 - 16 May 2015

Supervision in Nursing: Latvian sample study

- Kristaps Circenis. Tel.: +371 67061528

MBI reduced sense of personal accomplishment subscale 36.97±8.50 33.57±10.76 0.038

Contents lists available at SciVerse ScienceDirect

Nurse Education in Practice

A clinical supervision model in bachelor nursing education  Purpose, content

article info abstract

2013 Elsevier Ltd. All rights reserved.

1 Tel.: þ46 547001930.

Furthermore, the respondents perceived to a large extent that the students’

Personal preceptors Main preceptors Clinical lecturers Head nurses

Personal preceptors Main preceptors Clinical lecturers

Some important limitations must be addressed. The sample used,

Personal preceptors Main preceptors Clinical lecturers Head nurses

International Conference on Education & Educational Psychology 2013 (ICEEPSY 2013)

Clinical supervision: priority strategy to a better health

4. Corresponding author. Tel.: +351-22-5073500; fax: +351-22-

1877-0428 © 2013 The Authors. Published by Elsevier Ltd.

Table 1. Socio demographic data

SCC 0,162 0,056 0,187 -0,018 0,241 0,011 0,121 0,167

SCC – Spearman Correlation Coefficient; *Significant Correlation, significance level of 5%.

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