sep resubmit

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An Evaluation of Clinical

Psychology led Supervision Groupsfor Clinical Nurse Specialists

working in Oncology

Laura Charlton

Commissioned by Dr Nicky Tschernitz and Dr Merry Womphrey (Clinical

Psychologists), Department of Psycho-oncology, St James University Hospital, Leeds.

Word Count: 5000 words


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Table of contents

....................................................................................................Background 4

.................................................................. Political context for clinical psychology 4

.................................................................................................Clinical Supervision 4

....................................................................Stress and coping in oncology services 4

....................................................................Supervision need in oncology services 6

......................................................Clinical group supervision in oncology nursing 7

............................................................................The commissioning of this project 7

...................................................................................................Methodology 8

...................................................................................................................... Design

.............................................................................................................. Participants

................................................................................................................. Procedure

.................................................................................................................... Analysis

........................................................................................... Ethical Considerations

...........................................................................................................Results 11

........................................................................................................... Pilot Results

.................................................................................................Main Study Results 13

.........................................................................Discussion and conclusions 23

............................................................................... Reflections on a parallel study 24

............................................................................................................. Limitations

.................................................................................................. Recommendations

......................................................................................................... Dissemination

....................................................................................................References 26

Service Evaluation Project Evaluation of CNS Supervision Groups

Prepared on the Leeds D.Clin.Psychol. Programme, 2010


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...................................................................................................Appendices 27

..................................................................................... Appendix 1: Questionnaire

............................................................ Appendix 2: Participant information sheet 31

............................................................................. Appendix 3: Interview schedule 3

............................... Appendix 4: Qualitative information from the questionnaires 34

................................................................................................. Appendix 5: Poster


Prepared on the Leeds D.Clin.Psychol. Programme, 2010 3


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stresses that has an impact on oncology nurses, we might be better able to provide the

support that effectively ameliorates this stress. Hinds (1994) found that stressors and their

related reactions and consequences changed as time working as an oncology nurse

increased. Although there was overlap in some areas, new and more experienced nurses

were found to have distinct stressors. New nurses experienced stress as related to them

personally (for example, concerns about perceived ability) whereas more experienced

nurses cited stress being more related to systemic issues (such as poor management). Of

interest, is the nurses (3/9) that remained in post 12 months on, had developed similar

coping strategies as the experienced nurses, six months into their working life. They also

felt more supported and trusted by peers than the nurses that resigned from their posts.

This study makes clear that peer support may be a factor in the development of coping

skills in new nurses. Even gender differences were found in one study (Arvidsson et al.,

2008) with female nursing students feeling more supported, educated and professionally

developed as a result from process orientated group supervision than their male

counterparts who cited no significant changes. This finding may suggest that generic

support systems that are put in place may only be effective for a percentage of the group.

In an American study, Florio et al., (1998) used a transactional approach to

examine stress and coping amongst 59 oncology nurses. They found clusters of stresses/coping strategies and examined them in light of three cognitive appraisals; frequency,

intensity and controllability. Stresses that were rated high in frequency and intensity, were

rated as less controllable. These were also associated with increased levels of patient

contact and stresses that related to dealing with others (e.g. organisational issues).

Interestingly, the clusters relating to the personal impact of oncology nursing (e.g.

carryover stress) were rated as least frequent and intense and more controllable. Nurses

felt able to deal with stresses that had a personal association, but needed increased levelsof support when dealing with systemic stresses.

The evidence base has shown that stress cannot be considered to be a generic

concept and oncology nursing is associated with different types of stresses, all of which

are evaluated differently by nurses and have discrete levels of impact. As Florio




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demonstrated, work-related stress concept mapping may allow interventions to be

tailored specifically to nurse needs. However, the studies described here are innovative

and costly to carry out. Resources within NHS services are scarce and personal

reflections as a clinician is that the focus of resources tends to be on reducing waiting

times for treatment rather than improving the pastoral care of staff. Tailoring support

services for oncology nurses is clearly a goal that the NHS should be working towards,

but it may not be in a position to offer currently.

Supervision need in oncology services

Mental health difficulties, specifically anxiety and depression, are highly prevalent after

diagnosis of cancer (National Institute for Clinical Excellence; NICE, 2004). In oncology

services, NICE describes part of the role that support staff (such as clinical nurse

specialists) undertake, as ensuring that the mental health needs of patients are monitored

and attended to appropriately. This would either involve the correct identification of

mental health difficulties in patients and appropriate referral to specialist services or

containment of sub-clinical difficulties by staff members. As such, supervision groups

facilitated by staff with more specialist mental health training (such as clinical

psychologists) are recommended to assist with this process.In addition to training and supervision, clinical psychology has a role in

monitoring and preventing staff burn-out. Leiter, Harvie, and Frizzell, (1998) describe

burn-out as an umbrella term that covers three elements; increased exhaustion and

cynicism, leading to decreased levels of professional efficacy. Exhaustion, where one is

overextended in their role and as a result is lacking in physical and emotional resources.

As a result, cynicism may occur where the professional may feel indifferent towards

ones work. Finally, this leads to a lack of professional efficacy, which can be defined asa lacking sense of professional competence and accomplishment. This is common in

professions where there are busy schedules and a high emotional loading attached to the

job. Leiter et al., (1998) looked at the link between nurse burnout and patient satisfaction,

using patient satisfaction questionnaires (N=913) and compared this to scores of staff




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burnout (n=711) who worked on the unit the patient was treated on. They found negative

correlations with scores of patient satisfaction and nurse exhaustion (-0.73 p


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Aims

To understand what participants find most useful about the group and the impact

on their work.

To determine the perception of the current role of the Clinical Psychologist in the

group.

To explore the effects of the mix of professionals within the groups.

Methodology

Design

A mixed methods design was used to explore the research question. A

questionnaire used in a previous service evaluation project (MacIntyre, 2009) was

shortened and adapted to contain both fixed and open-ended questions (see appendix 1).

The questionnaire was intended to gather basic information and opinions about the

usefulness of the supervision groups. As this research area is still clearly in its infancy,

qualitative methodology was used to develop ideas about the impact of supervision on

nursing practice. A semi-structured interview schedule was developed from the

questionnaire responses to achieve this. The participants recruited for this study were

working under extreme time pressures and as such, the interviews had to be fairly time

limited. Developing an interview schedule from the questionnaire responses was felt to

be a way of conducting time-conscious interviews that fit within the bounds of

appropriate amounts of time that the staff had to offer, whilst still remaining a flexible

research method.




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Participants

The three clinical psychologists in the Psycho-Oncology department offer six

supervision groups across the Trust. Three of these are consist mainly of clinical nurse

specialist (CNS) staff members and three are mixed professional groups. For this study,

all participants were recruited from three CNS supervision groups. The other three groups

were evaluated as part of another evaluation project running parallel to this one. Seven

out of the twelve group members completed questionnaires. Of the seven who completed

the questionnaires, six agreed to interviews and five completed interviews. There was one

candidate who was unavailable to interview within the data collection time period. Four

participants were CNSs and one was a radiographer.

Procedure

Participants were approached either at the end of a regular supervision group

where the aims of the project were presented or via email. They were given an

information sheet (appendix 2) and invited to fill out the questionnaire and complete the

interview opt-in form at the end of the questionnaire. This was followed up with a

telephone call asking participants if they would like to take part. Participants who did

want to take part were then contacted by phone at a time convenient to them to take part

in the semi-structured interview (see appendix 3 for interview protocol). Interviews were

carried out over the phone or face-to-face and were tape recorded. Participants were made

aware that their responses were confidential and that they could stop the interview at any

time. The interviews were transcribed by the researcher.

Analysis

As little is known about oncology nurses experiences of supervision groups,

transcribed interviews were analysed using thematic analysis. Thematic analysis was

chosen as it looks for themes when individual experiences may differ significantly

(Ritchie, Spencer & OConnor, 2004). For this study, themes have been identified

through inductive analysis as this is data driven rather than theory driven (deductive




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analysis) and helps to reduce the impact of researchers preconceptions (Braun and Clark,

2006). Braun and Clarke describe 6 phases of thematic analysis (see Table 1).

Table 1. Phases of thematic analysis

Phase Description of the process

1 . F a m i l i a r i s i n g

yourself with your data

Transcribing data (if necessary), reading and re-reading

the data, noting down initial ideas.

2. Generating initial

codes

Coding interesting features of the data in a systematic

fashion across the entire data set, collating data relevant to

each code.

3. Searching for themes Collating codes into potential themes, gathering all data

relevant to each potential theme.

4. Reviewing themes Checking if the themes work in relation to the coded

extracts (Level 1) and the entire data set (Level 2),

generating a thematic map of the analysis.

5. Defining and naming

themes

Ongoing analysis to refine the specifics of each theme,

and the overall story the analysis tells, generating clear

definitions and names for each theme.

6. Producing the report The final opportunity for analysis. Selection of vivid,

compelling extract examples, final analysis of selected

extracts, relating back of the analysis to the research

question and literature, producing a scholarly report of the

analysis.

(Braun and Clarke, 2006, p.87)




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These phases were adhered to ensure reliability and the analysis was quality checked by

another researcher. In order to do this, a selection of data was sorted into the themes

generated by the researcher and was discussed with the researcher conducting the parallel

study with mixed professional groups.

Ethical Considerations

The Leeds Teaching Hospitals NHS Trust Research and Development department

confirmed that ethical approval would not be needed to carry out this evaluation project.

Informed consent was sought after using an information sheet (appendix 2) and consent

form. Participants were made aware that comments from the interviews may be made

available in the report or on a poster but anonymised to ensure confidentiality.

Results

Pilot Results

To make the questionnaire data more meaningful, the data from the CNS groups (N = 7,

60% response rate) were combined with data from the mixed professional groups (N=9,

45% response rate). Analysis of the questionnaires (N=16) revealed that the mean number

of groups attended was three. The mean number of years in role was three. Most people

had no previous experiences of supervision groups (9/14 respondents). The rest of the

pilot questionnaire data was completed using a likert scale (range 0-7). Higher scores

reveal greater levels of agreement with the statement and for the purposes of analysis,

scores above the halfway point (4) were regarded as indicating agreement with the

question. Most people agreed that the supervision groups were helpful (Mean rating 5.93

SD = 1.23). Respondents were asked about the helpful aspects of the supervision groups.

Table 2 demonstrates that Support was the most strongly advocated helpful aspect of

the groups (Mean 5.8 SD=1.2). The least agreed upon was that the supervision groups

changed practice, although this fell above the halfway mark and so was agreed to be a

moderately helpful aspect (Mean 4.3 SD =2.2).




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Figure

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Validation

Four out of the five professionals described sharing experiences within the supervision

groups as a validating experience. The professionals commented that the stressful nature

of work and decision making left them feeling doubtful that they had made the right

decision (as evidenced by box 1, participant 2.1). Supervision groups provide a forum to

share that experience with professionals in the same situation (2.2).

Box 1

Staff Wellbeing

All five participants identified supervision groups as an agent of maintaining staff

wellbeing. The main sub-theme was that the supervision group was able to provide an

appropriate outlet for feelings, with all five participants citing this as a useful element to

group supervision (For an example see participant 2.1 in box 2). With little time allowing

for reflection and the expression of feelings, supervision groups were an important factor

for maintaining staff well-being (Participant 1.2). Participant 1.2 also linked this

expression of emotion as not only important for them as an individual, but for the way

that they relate to patients problems as well.

Participant 3.1: I think it does help to discuss complex cases, just to talk them through.

Participant 2.1: if the team that youve had to interact with have reacted in a way that

you havent expected its useful to have that peer support not be able to talk through what

should you have done differently and often its nice to hear the others say, actually I

would have done it like that.

Participant 2.2: maybe some of it is reassurance so when I have found something really

difficult its good to know that its normal to find that difficult.




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Box 2

Team Building

Team building was not only a theme that was reflected when teams met for supervision,

but was also reflected when professionals who worked individually and then met for

group supervision. Team in this sense was the group membership to the supervision

group. There were two main sub-themes to team building. One of these was increasing

understanding about team members (two participants) and their differences and the other

was the opportunity to support others (three participants).

Increasing understanding about team members

Participants from one CNS team in particular talked about the supervision group offering

an opportunity to get to know your colleagues ( see Participant 1.2, box 4). The groups

help develop an appreciation and acceptance for working practice differences and ways

of doing things (See participant 1.4).

2.1sometimes its useful to offload somebody that you know has struck and chord and

you know what you shouldnt carry around that sort of baggage .

1.2: I suppose the main reason that motivates me is that its a time out phase.

1.2: some people say to do this job you have to be hard but the minute that happens, you

should not do this anymore. You need to remain human in my job and I need an outlet for

the way that I feel too.




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Box 4

Supporting others

The sense of improving team dynamics is carried over into this theme (see box 5) . It

seemed that staff got a sense of well being and a good feeling when they were able to

offer support to colleagues. There was also the opinion that supporting colleagues would

inevitably improve work and benefit patients (participant 2.2, box 5)

Box 5

Participant 1.2: it makes everything much more out in the open and helps you to realise

that we all have our own issues and our own ways of looking at things.

Participant 1.4 said, we all are very different in the way we handle situations and things

I feel comfortable with, others wont I suppose. So you know, although we can look and

think of different solutions we all have to be very aware that individuals will deal with

things very differently.



Participant 1.2: youve got here is an opportunity to give something back to others i think it

helps with team building because you get to know your colleagues a bit more and i think it

stops you from being judgmental about your collegues.

Participant 2.1: its erm sometimes still beneficial to listen to other peoples issues and it

feels positive when your able to give somebody that support that maybe last month theyve

given you .

Participant 2.2: my primary motivation for attending is to help my colleagues but the

offshoot is that you benefit patients as well.

Participant 1.1: offering the support for colleagues is really valuable .


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What impact, if any, has the supervision group had on your own work?

There is a lot over overlap with the themes that emerged from this question and the

previous question. One of the reasons why the participants are motivated to attend the

groups is that it has an impact on their clinical work. The participants seemed to struggle

with this question and found it hard to articulate the direct impact that the supervision

group had on their work, although all five participants felt that there was an impact. There

was a sense that the group helped the professionals communicate with patients better and

in some cases feel more confident in further engaging in conversations.

New perspectives

All five professionals cited this as an important reason for attending the supervision

group. The focus was about gaining new perspectives on complex cases from both the

supervisors and other work colleagues. For examples see box 6.

Box 6

Increasing sense of competence in communicating with patients

Four participants reported feeling an increasing sense of competence as a result of

attending supervision groups. Respondents spoke of improving communication skills (for

example, Participant 3.1, box 7). One participant (2.1, box 7) linked improved

communication skills to improving the supervision she was able to give colleagues. One

participant linked the supervision group to helping her engage more with patients,

enabling her to have more conversations about difficult topics; (participant 2.2, box 7)



Participant 2.1 (the group) helps give you some direction if your not sure where you

want to go with somebody so yeah I think it helps improve my patient care.

Participant 3.1 you get different angles form the different professionals that are other

CNSs and from psychology services as well, I think thats the main reason that I go


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Box 7

How does group supervision differ from your other experiences of supervision?

For many of the nurses, this was their first experience of formal supervision. Three

themes were yielded from this question.

No previous experience of supervision

None of the interviewees had attended group supervision before and only two participants

(1.2, 2.1) had received clinical supervision before. One had supervision with one of the

clinical psychologists in the psycho-oncology department and the other because she had

worked in a mental health service previously. The other professionals had not

experienced supervision where they discussed clinical cases.



Participant 3.1: I know it has been helpful for our workloads and improving communication skills

with patients, I know it has.

Participant 2.1 Interviewer: do you think its changed the way that you work with colleagues and

had an impact in those ways? Respondent: well I suppose in some ways because I suppose to a

certain extent I provide supervision for other professionals and they can come and offload to me. So

I suppose to a certain extent it does because you improve your communication skills with interaction

skills.

Participant 2.2: Theyve given me advice for specific patients that made me feel more enabled to dig

a bit further and expose myself more to their anger and to do it in a positive way where Im sort of

trying to engage with them more ... I did feel that Id dealt with it well and I was able to say I can

see you are really angry and this is hard and I felt more able to engage with him about that and

that came out... I felt that we tried for a bit further and I think since then I felt that I can dig around

and I felt brave about it.)


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Patient focus

One other nurse (2.2) talked about how they had been to meetings that focused on the

managerial aspects of the role.Participant 1.2 agreed with this statement but enjoyed the

group aspect of discussing patient scenarios as she found this less attacking to her

personally than when the focus is on her as an individual practitioner.

Protected space

Two nurses (1.4, 3.1) talked about how they had sought advice through less formalised

peer support networks but this was different because of the time and space boundaries

imposed the group. This nurse also said that the regular time slot initiated more

reflection, as she would do this in preparation for group supervision.

Box 8

What is it like having a clinical psychologist supervise the group?

Expertise of psychologists

All five participants felt that the psychologists had a high level of expertise and two main

themes emerged; knowledge and skills and skill at facilitating group processes.

Psychological knowledge and skills

Four interviewees discussed how the knowledge and skills that clinical psychologists

bring to group supervision help with the quality of supervision received.The nurses value

the high academic standard that the clinical psychology profession demands (see

participants 3.1 and 1.2, box 9). One person (1.4) also talked about how the experience of

the psychologist helped with the process of supervision.



Participant 2.2: Other experiences of supervision were about how to manage my

caseload, equity of careand that the group gives more focus to the more psychological

side of things

Participant 3.1: youve got a regular time slot so its very good that you can prioritise

your time.


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Box 9

Skill at facilitating group processes

Three participants commented on the expertise that clinical psychologists demonstrate in

facilitating the supervision groups. Two participants valued the way that everybody was

included in discussion and participation is encouraged (see participants 1.4 and 1.2, box

10).One participant (2.1) doubted whether the group function as well without facilitation

by a clinical psychologist.

Box 10

Participant 3.1: they are very good.

Participant 1.2: you need someone clever enough to push your buttons .

Participant 1.4: shes got a great understanding of our role and sort of the patient that

we are meeting so very infrequently do we have to explain in any great detail.



Participant 1.4: although we meet in a group everyone is asked is this something they

want to discuss .

Participant 1.2:its sometimes about sharing how youre feeling and getting it off your

chest and you have the advantage of a supervisor... they encourage you to do that .

Participant 2.1:if we try to do it without the clinical psychologist then it would be more

difficult to make sure that the quieter members of the group get as much either

encouraging or you know that there voice in heard and that their issues are discussed.


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Challenges

There were some challenges identified by participants. Two nurses cited difficulties in

attendance and linked these to high workloads and feeling that some clinical situations

take precedence (participants 2.1 box 11). One participant (1.2) spoke about the finding it

challenging to share some things in a group environment. Another spoke about how

sometimes there were remaining difficulties after supervision. This participant seemed

unsure about how these issues should be dealt with, especially when some need was

identified in the supervision group (see participant 1.4, box 11).

Box 11



Participant 2.1: its just that because we have to stick to a rigid time now its more

difficult to always be able to get to whereas before we had some flexibility

Participant 1.4: its just hard to deal with if youve got somebody who've talked about

a problematic issues theyve then show their emotion theyre upset and you dont

want to make that worse but youve still got a patient problem with that individual

that you've got to resolve. i


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Reflections on a parallel study

Meeting the needs of multiple people in group supervision is a difficult task. A service

evaluation project was conducted in parallel to this study, using the same methodology

(and the same clinical psychologists supervising) with groups that contained mixed

professionals as opposed to clinical nurse specialists. The poster in appendix 5

summarises the results of this study. The mixed professionals groups overall felt less

positive about their supervisory experiences than did the CNSs. One major difference

was that discussions of challenges within the NHS system dominated the interviews for

this study.

This study reflects the challenges associated with offering generic support

systems to staff and corroborates the findings of the literature review. More importantly,

it also is evidence of how it may be necessary to have groups of staff members who

experience similar types of stressors in their role. It is possible that the current study

yielded a more positive response than the parallel study because the groups were more

homogenous. However, with the limited resources and time of austerity for the NHS,

individual supervision of oncology nurses might prove too costly for administrators to

justify. One has to question however, the effectiveness of the group supervision at all

when it may be too general to meet the specific needs of the professional attending.

Limitations

There were a number of limitations to this evaluation project. This study is limited by the

small number of CNS available to interview. It is possible that the data set would have

been enriched by a greater number of interviewees.

Another limitation was that the questions asked as part of the interview may have

been slightly biased generate positive answers. The benefits to attending supervision

group were asked, but not the limitations. However, the interview questions were

developed from the responses received from the quantitative part of the study. As these

questionnaires yielded positive comments, the questions asked at interview followed on




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from these. The interviews were time limited ( to ensure greater participation in the

project) and so only a small amount of questions were asked at interview.

Recommendations

The following clinical recommendations are made as a result of this evaluation project:

It is recommended that clinical psychologists continue to provide group supervision to

the oncology CNSs. This is based on the fact that benefit is derived from the group and

that clinical psychologists were valued as facilitators.

As this was the first experience of supervision for many of the nurses, the aims and

objectives of supervision need to be made clear and regularly re-negotiated.

As attendance is difficult for the CNSs due to high workloads, it should be negotiated

that the supervision groups should be included in their job plans to make attendance

easier.

Following on from the literature review and differences between this study and the

parallel project, group membership should be made as homogenous as possible. This

may mean that different groups are offered for newer and more experienced group

members, particularly those in a leadership role.

The focus of the supervision group should be tailored to meet the needs of the particular

stresses experienced by the professionals at that time. As such, the topics of the group

should continue to be group led.

Dissemination

A brief summary of results was delivered at the doctorate in clinical psychology SEP

conference (University of Leeds) in October 2010. It will also be arranged that the results

will be discussed with the CNS supervision groups at their request. This will be arranged

in collaboration with the clinical psychologists who facilitate the groups. In addition, the

results will be disseminated at a staff meeting for the clinical psychologists and their

associates.




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References

Arvidsson, B., Baigi, A., Skarsater, I. (2008) Changes in the effects of process-oriented

group supervision as reported by female and male nursing students: a prospective longitudinal study. Scandinavian Journal of Caring Science, (22) 437-444.Arvidsson, B., Lonfgren, H., & Fridlund, B. (2001). Psychiatric nurses' conceptions of

how a group supervision programme in nursing care influences their professional competence: a 4-year follow-up study. Journal of Nursing Management, 9(3), 161-171.Braun, V., Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research

in Psychology, 3(2), 77-101.Florio, G. A., Donelly, J. P., & Zevon, M. A. (1998). The structure of work-related stress

and coping among oncology nurses in high-sress medical settings: a transactional analysis.Journal of Occupational Health Psychology, 3, 227-242.Hinds, P. S., Quargnenti, A. G., & Hickey, S. S. (1994). A comparison of the

stress- response sequence n new and experienced pediatric oncology nurses. Cancer Nursing, 17(1), 61-71.Jones, A. (2003). Some benefits experienced by hospice nurses from group clinical

supervision.European Journal of Cancer Care, 12(3), 224-232.Jones, A. (2006). Group-format clinical supervision for hospice nurses.European Journal

of Cancer Care, 15, 155-162.Lavender, T. & Hope, R. (2007). New Ways of Working for Applied Psychologists in

Health and Social Care The End of the Beginning. British Psychological Society:

Leicester.

Leiter, M. P., Harvie, P., & Frizzell, C. (1998). The correspondance of patient satisfaction

and nurse burnout.47(10), 1611-1617.MaIntyre, A. (2009). An Evaluation of Supervision Groups Provided to Clinical Nurse

Specialists Working with Families with Chronic Illness. Unpublished service evaluation project. University of Leeds, Leeds.




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National Institute for Clinical Excellence (2004). Improving Supportive and Palliative

Care for Adults with Cancer: the manual.Ritchie, J., Spencer, L. & OConnor, W. (2004). Carrying out qualitative analysis. In J.

Ritchie & L. Lewis (Eds.). Qualitative Research and Practice: A guide for social

science students and researchers. London: Sage

Scaife, J. (2001). Supervision in the Mental Health Professions. East Sussex:

Brunner-Routledge.

AppendicesAppendix 1: Questionnaire

1. Gender (please tick):Female Male

2. Professional Role (please write below):

---------------------------------------------------------------------------------------------------------------

3. Number of years in this role (please tick):

0-2 3-5 5-10 10-15 15-20 20+

4. During the last year, approximately how many supervision groups have youattended?

1-2 3-5 6-8 8-10 11+

5. Have you attended a similar supervision group in the past?

YES NO

10. How helpful do you find attending the supervision group?

Not at 1 2 3 4 5 6 7 Extremelyall helpful neutral helpful

11. What are the most helpful aspects of the supervision group?




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12. What are the least helpful, or unhelpful, aspects of the supervision group?

13. What could be done to improve the supervision group to suit your needs?

14. Have you ever found it difficult to attend the supervision group?

YES NO

If yes, please describe what has made it difficult to attend:

15. What do you feel you gain from attending the supervision group?(Please circle the number you feel best corresponds with your experience)

a) Support from peers

Doesnt AppliesApply 1 2 3 4 5 6 7 Very Much

b) Changing the way I practice


c) Dealing with difficulties or challenges in the work


d) Dealing with the emotional impact of the work




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e) Understanding of self in relation to the work


f) Personal coping strategies


g.) Developing psychological knowledge and skillsDoesnt AppliesApply 1 2 3 4 5 6 7 Very Much

If there are any important things you feel you gain from supervision groups thatare not listed above please describe below:

Any other feedback:




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MANY THANKS FOR TAKING THE TIME TO COMPLETETHIS SURVEY WE VERY MUCH APPRECIATE IT

Evaluation of Supervision Groups Questionnaire

Request for Further Information:

If you would be willing to take part in a brief telephone interview lasting 20-30minutes regarding your experiences of attending the supervision group thenplease write your name, a telephone number that you wish to be contacted on(mobiles/personal phones are fine), and a convenient time for us to give you acall. We are happy to talk at evenings and weekends or whenever might be mostconvenient for you. If you would rather talk in person then we are also happy tomeet with you at St James. All personal information will be kept confidential andwill be destroyed once we have completed the interviews.

Name: __________________________________________________

I would be happy to speak with you on the telephone / meet with you in person(please delete as appropriate).

Telephone numbers (in order of preference): ______________________________________________________________________________

Convenient times (24h clock):________________________________________________________________

For those who do not wish to take part:We understand that not everyone will wish to take part or may not be able to. Ifyou do not wish to take part in this section of the evaluation it would be veryuseful for us to know what it was that prevented you. We would be most gratefulif you could briefly describe your reasons below. We are very grateful for yourcompleting our survey.




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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

THANK YOU FOR YOUR TIME.Appendix 2: Participant information sheet

Participant information sheet for the Service Evaluation Project

This is an invitation to take part in a service evaluation project.

What is the purpose of the project?

Clinical Psychologists provide supervision to staff individually and in group settings,

however there is little research about the contribution this makes to staff, in particular those

working in Oncology settings. The project aims to evaluate the staff supervision groups led

by Clinical Psychology within Oncology services. We are interested in looking at the

contribution these groups make to you and your work.

Do I have to take part?

It is up to you to decide whether to take part or not. If you decide to participate you will be

given this information sheet to keep and asked to sign a consent form. If you decide to take

part you are free to withdraw at any time and without giving a reason. A decision to

withdraw or not to take part will not affect your supervision in any way. The information

that you give is confidential and will not be shared with the supervisors until it has been

analysed and made anonymous. If you are interested in taking part we are happy to answer

any questions you may have.

What will I have to do if I take part?You will be asked to a complete a short survey. Once these have been collected, we hope

that some people will agree to participate in a more in-depth interview lasting roughly 15 to

20 minutes. This will be done at your convenience; face-to-face or over the telephone if

preferred.

Are there any possible advantages of taking part?




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There are no personal advantages to taking part; however, the evaluation of this service may

provide useful information for the development of future supervision groups offered by

Clinical Psychology.

What happens to the information about me and to the service evaluation project ?

All of the information you provide is confidential and will be anonymous once the data iscollected and written up no one will be able to tell who you are. At the end of the project

we will prepare a poster presentation and brief report documenting our findings. You are

welcome to attend the poster conference if you so wish. Details of this can be obtained

from the university below.

Ms Laura Charlton and Dr Bridie Ghallagher.Psychologists in Clinical Training (DClinPsychol)

Clinical Psychology Programme

Institute of Health Sciences

University of Leeds

Charles Thackrah Building

101 Clarendon Road

Leeds

LS2 9LJ

Appendix 3: Interview schedule

Questions

1. What are the reasons that motivate you to attend the supervision groups?

Prompts

What do you gain?

Is it a requirement?

What do you like about it?

2. How is the supervision group different from your other experiences of

supervision?

Prompts




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Appendix 4: Qualitative information from the questionnaires

Question 8: What are the least helpful, or unhelpful, aspects of the supervision group?

1.3 While I appreciate the importance and support it has provided, I always feel that

time constraints of work seem to dominate my thinking.

Sometimes discussion dominated by vocal members of the group.

Nothing feels unhelpful!

None

Possible work in more specific things we could do differently - personallychallenge us more or maybe do educational bits. This might not suit everyone in

a group setting. ? Use tapes, videos...

When we chatter - enjoyable - but off the point sometimes and waste of time; if

pushed for time/stressed can be annoying - even when I do it!

Question 10: Please descibe what has made it difficult to attend

1.4 If patient in clinic feel I need to support them but usually negotiate that I will

ring them later. However it increases my stress levels.

2.1 Last minute clinical situations I wasnt expecting have occasionally occurred but

I dont think these can be resolved!

of the group.

2.2 Clinical workload and last minute referrals. But this is as good a time for asession as any other!




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Appendix 5: Poster

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