Our journey with clinical supervision in an intensive care unit

In 1991, the nursing profession began to pursue the idea of reflective practice with vigour, despite little evidence that reflective practice improved nursing care (Burnard 1991; Hunt 1993). A small qualitative study on the experiences of nurses writing reflective journals was undertaken in the intensive care unit at Newham General Hospital. (A Price 1995). This highlighted the need for clear initial guidance and support when introducing reflective practice. It also demonstrated a lack of knowledge about reflection within the unit. During this time, a group of nurses who were interested in developing clinical supervision as a method of support for staff was formed. Kohner's (1994) definition of clinical supervision, adopted by the group after review of literature, makes it clear that this involves reflection on practice. Johns' (1993) Model of Structured Reflection was amended and used to promote in-depth analysis of situations, and journal writing was encouraged within the group. A continuing process of group clinical supervision was started, initially with the help of a facilitator experienced in it. On the basis of this experience, a strategy for implementation of clinical supervision in the intensive care unit was developed and put into action by the group members. Consideration of the progress and problems experienced leads to the conclusion that continuing staff motivation and commitment, and adequate time are essential for implementation of clinical supervision.