EFFECTIVE SUPERVISION

(Module 6 requirement)

In Partial Fulfillment

Of the Requirements for the

Nursing Administration

By:

MARIA WILEN C. BUYSER

September 24, 2010

Submitted to:

Professor Cresencia Manlangit

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Table of Contents

I. Introduction....................................................................................... 3

II. What is Supervision? ....................................................................... 4

III. Purposes of Good Supervision ........................................................ 6

IV. Supervision Uses Teaching ............................................................. 7

V. Supervision Includes Giving Directions ........................................... 17

VI. Supervision Includes Observation ................................................... 21

VII. Supervision Includes Evaluation ................................................ 32

VIII. Statement of Summary and Conclusion .................................... 33

Bibliography .......................................................................................... 34

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I. Introduction

I have been working for almost 13 years. The first ten (10) years of being a

member of the workforce was in the private sector, and my last three (3) years are

dedicated to public service.

I have been exposed to different types of supervisors. In my first work in a

telecommunications company, I had the privilege to work under five (5) unique

individuals with different statures, work ethics, and personalities. On my second job as a

nurse, I already worked under three (3) supervisors who also exhibit their own values

and principles. It goes to show that every individual whether a superior or a subordinate

have their own mind sets, and motivation. It is how a superior can effectively supervise

a subordinate to meet the organizational goals is the greatest challenge in any private

or public institution.

Effective supervision provides a route to developing and maintaining emotionally

healthier individuals in an emotionally healthier work-force culture. Effective systems of

supervision can bring benefits not only to practitioners but also to the organization and

its clients. This is particularly relevant now with the wave after wave of changes that are

hitting the healthcare industry. All change, however beneficial, involves some feelings

of loss, and in the need to implement change, these feelings can get buried, with

subsequent negative consequences. Supervision can provide a safe forum for

practitioners both to catch up with and work through their own reactions to these

changes.

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II. What is Supervision?

The word supervision conveys different ideas to different people. It is most often

believed to be the inspection and checking of a worker’s performance by someone who

looks only for things that are being done wrong. In this conception, the emphasis of

supervision is placed on getting the work done according to definite policies and

procedures. The supervisor plans all the work, makes all the decisions, and issues

commands to the workers, who are to obey them without question. This is the traditional

autocratic form of supervision, which has been practiced in industry and nursing for

many years. It stifles both the initiative and the productivity of the individual and seems

to regard the individual as a machine rather than as a human being.

Gradually, however, business and education are changing their ideas about

supervision from the dictatorial to a more democratic form. The emphasis, instead of

being on getting the work done, is now being placed on helping the individual do his

work better. There is a greater degree of democracy and freedom, with the worker being

given a voice in setting up of work goals and planning methods for reaching them. The

nursing profession is also beginning to accept these changing concepts of

management. The implication of team nursing points to the belief that a group of people

thinking, planning, and working together with competent supervision can give better

nursing care than was possible under the older method of direction in functional nursing.

As with leadership, it is difficult to find a satisfactory definition of supervision,

although it is very easy to describe the traits of a good supervisor and to determine the

results of supervision. Effective supervision employs techniques from many fields of

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endeavour – communication, human relations, personnel management, education, and

others – in order to accomplish its aims. It deals, basically, with people and their

personal growth; therefore, as in management, leadership is fundamental to good

supervision.

The quantity and quality of supervision will be determined by the individual’s

philosophy and ability to use the techniques on which supervision is founded. An

individual who is overly directive by nature is likely to “drive” rather than “lead”, which

results in a do-as-I tell you kind of supervision. One who believes in creative leadership

will supervise more democratically. In one, the supervision given will be direction and

inspection; in the other, it will become teaching and helping workers develop new skills

and a greater understanding of their jobs.

More democratic supervision is needed in nursing today, but it can be obtained

only when nursing leaders believe in the worth and dignity of each person as an

individual, and when they become willing to assume the responsibilities inherent in

leadership, in administration, and in management. Experience as a leader in team

nursing allows the registered nurse to gain experience in the necessary techniques and

provides an unlimited field in which to practice the skills demanded by the democratic

leadership.

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III. Purpose of Good Supervision

Since supervision is concerned with workers, it must also be concerned with the

area in which they work – their working conditions – as well as with the work itself. The

supervisor must try to provide, as much as possible, suitable working conditions. This

involves not only the physical surroundings but also the atmosphere in which the staff

works. It includes the quantity of supplies and available equipment and the ease with

which they can be obtained. The environment in which people work should give them a

feeling of freedom and the desire to do the best they can. The supervisor cultivates a

spirit of cooperation, as evidenced by the emphasis on “we” rather than “I”. Policies and

procedures are formulated by the group and guided by the supervisor.

The supervisor is also concerned with the planning, execution, and evaluation of

the work to be done. However, the workers, again guided by the supervisors, have a

part in this planning and are helped to perform and evaluate their own work. On

occasion, the supervisor may need to employ problem-solving techniques and

experiments in order to find better methods for performing the duties delegated to the

group; however, the supervisor will also seek suggestions from the members of the

group.

Although the supervisor is interested in the working conditions and the work

being done, of primary concern is the worker. One of the main aims of supervision, if not

the principal one, is the orientation, training, and guidance of individuals, based upon

their needs and directed toward the utilization of their capabilities and the development

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of new skills. The supervisor must be acquainted with each individual and be able to

stimulate within each person the desire for self-improvement.

After the person recognize a need to improve, the supervisor must supply the

necessary help and instruction, at the same time guiding the worker in the acquisition of

acceptable attitudes, interests, and good work habits.

In nursing there is a direct relationship between the help workers receive and the

quality of the care they are able to give. In other word, the care given by

nonprofessional workers will be only as good as the help or supervision they receive.

Just as the nonprofessional person needs help to do his job, so also do the staff

nurse, the nursing student, the head nurse, and others. In fact, in any position there

comes a time when a person needs advice and guidance from someone more

experienced. Supervision then can be described as guided learning.

IV. Supervision Uses Teaching

Supervision in itself is not teaching, yet it must make use of some teaching skills

as a means of helping the worker. This can be done easily and effectively while the

nurse works with the staff.

What is learning?

Learning does not always ensure the acquisition of understanding and wisdom.

Funk and Wagnalls defines as “the process of getting knowledge,” and knowledge as

“the aggregation of facts and principles, acquired and retained,” thus implying that a

certain amount of active participation on the part of the learner is necessary. Wisdom

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and understanding, on the other hand, implying the ability to put knowledge into practice

through the use of judgment and the power to make decisions.

Some fallacies concerning teaching

Two fallacies concerning teaching need to be considered. The first involves the

belief that the facts and information have been presented, learning has taken place, and

the teacher’s work is finished. Frequently, when trying to determine the reason for an

error, a teacher may exclaim, “But I taught her how to do it!” what this teacher really

means is, “I told her how to do it.” Merely giving a certain amount of information in no

way guarantees the learning of it; learning will not occur unless the learner wishes to

acquire that knowledge. Certainly the ability to repeat the information thus acquired

does not, in itself, indicate understanding, which is the ability to apply knowledge in a

practical way.

Schools of nursing often emphasize the acquisition of knowledge but pay little

attention to the degree of understanding that the nursing student acquires or needs.

Most examinations in nursing are objective in form and stress recognition of facts, rather

than the application of those facts to individual patients. So-called situation questions

are difficult to formulate, especially those that will give a valid evaluation of a student’s

understanding of actual nursing problems. Yet the acquisition of this understanding is

extremely important if we are to have well-prepared nurses who are capable of

assuming leadership roles in the various nursing fields.

Teachers can never assume that what they think they have taught and what their

students have actually learned are the same. One day, while supervising her students,

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a nursing instructor saw one student bathing a patient who was inadequately draped.

The instructor discussed the reasons for draping, and the student indicated his

knowledge of the various acceptable methods that could be used. Several days later the

teacher came into a room while this same student was again bathing a patient who was

incorrectly covered. The student’s explanation was “I didn’t think you were coming

around today!” The instructor thought she had taught the student to cover all his

patients correctly. Actually, the student had learned only that he must cover the patient

whenever the instructor was observing.

Another common fallacy concerns the belief that teaching can be done only in a

classroom. Nothing is further from the truth. Teaching and learning can occur at any

time and in any place. Probably one of the important methods of teaching is by

example; people learn from watching and listening to others. Attitudes, ideas, beliefs,

even ways of doing things, are passed on from one person to another in this way. The

adage “What you do speaks so loudly I can’t hear what you say” is especially true in

nursing. Those methods of nursing care that a person observes and practices on the

hospital wards will be remembered much longer than the methods described, or even

demonstrated, in the classroom. A graduate nurse may say, “I could never be a

teacher,” yet the staff nurse is one of the most important teachers in nursing today,

because others will do as they see this nurse do. Many a person has learned to make a

bed correctly while a patient in the hospital. Moreover, the nursing assistants, L.P.N.’s,

and nursing students will watch and follow the example of the registered nurse

practitioner as they care for their patients.

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The results of learning

The final result of learning is a change in behavior and may involve mental,

emotional, or physical activity. In other words, learning may change people’s thoughts

and ideas, their attitudes, or their way of doing things. The manifestations of these

changes will vary according to the individual’s capacity or opportunity for self-expression

and will not be noted until a situation arises in which that learning must be used. A

person may respond in a certain way because of the teaching that was received weeks,

months, or even years previously. Learning took place at that time, but evidence of the

learning did not appear until the individual had occasion to apply the knowledge.

Four steps to use in teaching

As a professional nurse, you will need to apply your entire knowledge of medical

therapy and nursing principles as you try to improve the care of your patients. You will

need to increase your understanding of people and their reactions, not only of your

patients but your co-workers and yourself as well. In addition, you will need to use

various methods of teaching to help your group to acquire more knowledge and

understanding of what good nursing care entails.

The four main steps to effective teaching are prepare, present, practise, and

follow up. Each step is important and leads naturally into the following one.

Prepare

This includes the preparation of the learner as well as the preparation of yourself

as teacher. First of all, you should decide what you want the person to learn. Go over

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the sequence of points in your own mind or jot them down in the form of a written

outline. Make certain that all material is arranged in logical order. You must give some

thought also to the prerequisite knowledge that is necessary if the person is to

understand what you hope to teach. Decide how you want to present your information.

Don’t use the same method all the time. Have all the necessary equipment available

before you begin, it goes without saying that you must know your subject.

After you have decided what and how, you must find out how much the learner

knows about the subject already, or what background knowledge that person has. For

example, it would be difficult to teach someone who does not understand the meaning

of cc. or oz. on measuring devices how to measure output. Start with what someone

knows, and proceed to the unknown. Always try to relate the information to what is

already understood. Do not assume that because a procedure is routine or the

information is simple to you, it will be routine or simple to someone else.

Try to put the person at ease, physically as well as emotionally. External

distraction should be minimized as much as possible. At the same time, you should try

to show the learner why the material being presented is important and how it will help in

giving good patient care. In other words, try to arouse the learner’s interest in the

subject. Learning occurs with greater rapidity when the learner is receptive, that is, at

ease and interested.

Present

This second step is made up of two parts --- telling and showing. Sometimes

discussion may precede demonstration. Often, however, they are combined into a

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single operation, but both steps should be used to make your teaching more

understandable.

Consider first how to present telling. Here you must use all the techniques

previously discussed in relation to communication --- both verbal and nonverbal. Use

simple terms that can be understood by the learner. There is no need to show off your

complete knowledge of the subject. A good teacher knows how to sort out and use only

that information needed by the learner. Giving too much explanation might cause

confusion, thereby retarding the learning process.

Make your instruction personal to the learners, repeatedly telling them how they

can make use of it. Use illustrations familiar to them, yet ones that are related to the

new material being presented. For instance, if you are describing a new method for

preventing bedsores, show them how ones of their own patients could be helped by this

method.

Another important part in presentation is determining that the learners

understand what you are telling them and that they are interpreting what you say

correctly. If they do not seem to understand, be patient. Whenever it is necessary to

repeat, try a different approach, using different words either to define the terms that

were not understood or to restate the information. Technical abbreviations or medical

terminology, such as hemiplegia or mediastinum, may not be completely understood by

young nursing students or nonprofessional persons, even though they may use them

quite glibly. Unless you are trying to teach the meaning and correct usage of terms, try

to avoid using very technical language.

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Always put in positive terms those things that a person is expected to do; use the

negative, specifying things not to do, when you want to emphasize precautions

necessary for the safety of the patient. In both cases, you should give a brief and simple

explanation of the purpose of the procedures or the reasons for the treatment the

patient is receiving. It is very important that the person, especially the nonprofessional

person, gain an adequate understanding of the total care that the patient needs.

A seriously injured accident victim, who had a tracheostomy to facilitate

suctioning, was admitted to a surgical ward. A nurse asked a nurse’s aide to help in the

care of this patient and then instructed the aide in giving part of the care. Later the

nurse was shocked to overhear this nurse’s aide exclaim to another aide. “If I am ever

hurt, I don’t want to come to this hospital. The first thing they do is slit your throat!”

Clearly this aide did not understand the importance of the tracheostomy in the treatment

of this patient. Furthermore, the aide would probably discuss these feelings not only wit

hospital personnel but also with people outside the hospital, thereby creating a problem

in public relations. Perhaps a few additional words by the nurse as the two worked

together would have increased the aide’s understanding and, consequently,

appreciation of the treatment necessary for this patient.

However, explanation alone is sometimes not enough. Verbal illustrations, while

helpful, cannot take the place of visual aids. Therefore, demonstration is also an

important aspect of teaching. The power of your setting the example has already been

mentioned: it may be described as an informal demonstration of nursing care or

behavior that other will observe and perhaps learn. Visual aids definitely help to develop

a better understanding of information and foster retention of facts. They may be used to

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demonstrate ways of giving certain aspects of patient care or to explain reasons for

giving the care to a certain way. Examples of visual aids that you could use to make

your teaching more interesting and understandable include pictures, models, sample

equipment, and demonstrations of the procedure itself.

When giving a demonstration, go through it slowly, taking one step at a time.

Additional explanation should be given throughout, even though you may have given

some preliminary information already. Show the easiest way to do the procedure,

stressing the precautions and reasons for doing each step. This explanation should not

be lengthy nor be given in technical terms. Keep in mind that the simpler the

explanation, the easier it will be for the learner to understand and remember.

Place learners so that they can see clearly each step of the demonstration,

preferably from the same angle they will use when they do it themselves. In other

words, if you are teaching someone how to tie a square knot, the person should be

watching from behind you rather than facing you, so that your movements and the

appearance of the knot will not be reversed.

Allow time for comments and questions. When the procedure is difficult or long,

repetition will probably be necessary. The fact the learner does not ask questions does

not always indicate understanding. Sometimes lack of comprehension is so great that

people are unable to ask question, or they may think they understand when in reality

they do not. Therefore, you should ask a few questions yourself to determine if you are

getting your information across.

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Practice

Doing a procedure, or putting information into practice, is a necessary step in the

learning process. It also gives you the opportunity to check the correctness of the

person’s learning. At first, this practice must be done under your supervision, the

closeness of which will be determined by the past experience of the individual and by

the complexity of the procedure. Do not offer too much assistance in the actual

performance. It is usually best to suggest the correct method rather than taking over

and doing it yourself. For example, you may suggest:

Don’t you think it would be easier if...?

Remember, there is something else that should be done first.

Do you remember what I did next?

Now stop and think a minute before you do that.

The average person needs several practice periods in order to develop manual

dexterity and to remember the proper sequence of the steps necessary for a given

procedure. Give encouragement as the learner shows improvement and gains self-

confidence. The amount of help and direction may be decreased as the worker shows

evidence of learning; however, a certain amount of supervision will always be

necessary. You can never leave the learners to practice entirely on their own.

Follow up

Additional checking at intervals is a necessary and important aspect of teaching.

Observe as the individual performs the entire procedure; look at the finished product;

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ask some questions to determine whether the worker remembers the reasons for giving

the care and the precautions necessary for the safety of the patient. Suggest ways

performance can be improved, but be very sure to compliment the worker on those

parts of the job the worker did well.

The follow-up process is a very important part of teaching. Although you have been

constantly evaluating the progress of the learner, this final evaluation is necessary to

determine how much has been learned and in what areas the learner needs additional

helps. Teaching is the part of leadership that is a continuous process of helping

individuals improve in the performance of their work.

This discussion may make the teaching of good nursing care seem a lengthy and

somewhat complicated process; however, this is not true. For example, suppose that

as your= are passing out medications, you observe a nurse’s aide trying to release the

side rails on the patient’s bed. They are new and somewhat different from the ones

previously used, and she is unable to remove them. She is already in a situation that

has prepared her being taught; you need only to introduce your instruction by saying,

“Let me help you” Your presentation of the method and its demonstration may consist

of, “To lower this side rail, just remove these two pins. This unlocks the rail. Now you

can fold it together like this. Then fasten it here so that the rail is out of the way. Just to

be safe, always press down on the rail to make sure that it is locked securely.” She

watches while you lower the rail and lock it in place, then she goes around to the other

side of the bed and released the other rail. This is her practice period. You have taught;

she has learned. The time involved was probably not over three minutes.

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Perhaps you overhear one of your group saying, “I don’t see why we have to get

old Mr. Dela Cruz up in the chair every day. All we do is lift him from one place to

another.” Here is a good opportunity to do some teaching by answering the implied

question, and thus increasing the understanding of the purpose for this aspect of the

patient’s treatment in relation to his needs. You can give the information immediately, or

you can bring the incident up during the discussion at a nursing care conference so that

the entire group will benefit from the explanation.

Teaching including the subsequent follow-up or observation is fundamental to

good supervision. Each member of your staff must know what to do and how to do it. It

is your responsibility to give each the opportunity to acquire this knowledge whenever it

is needed. Teaching may also be necessary to help your staff acquire acceptable

attitudes, better appreciation of their contributions to patient care, and a clearer

understanding of their responsibility to the patient.

V. Supervision Includes Giving Directions

After you make the decisions about work to be done and who is to do it, you must

pass on that information in the form of directions to your staff. Giving direction is an

important managerial function and, when done effectively, enhances the nurse’s

leadership of the staff.

Making your direction effective

To be valuable, directions must be given sa that people know what they are to

do, to whom, and when.

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1. Directions must be complete. Include all the necessary information when you

give directions. Not only must workers know what they are to do and when;

they must each know how you want them to do the work and why it must be

done in a certain way at a certain time. Be very specific in your instructions.

2. Directions must be understandable. Use words that the person can

understand, and explain new words as they are introduced. Poor grammar

may also result in misunderstanding. The placement of words in a sentence

gives meaning by indicating relationships. When the placement is wrong,

exact meaning is lost. Faulty reference of pronouns is especially likely to

result in such misunderstanding. The pronouns it, this, that those, and them

must be used very carefully. For clarity, use the exact word rather than a

pronoun, or make certain there is no question concerning its reference. Avoid

abbreviations and technical terms unless you are very certain they are

understood. For example, if you direct a nurse’s aide to “check Mrs. Smith for

discharge.” make sure that the aide understands whether you mean ”for

drainage” or “to go home”

3. The wording of a direction indicated its importance. The use of must, shall or

will, or is to indicate that an action is mandatory. May is used if an action is

recommended. Should express an intermediate sense, the borderline

between mandatory and recommended action.

4. Speak distinctly and slowly. Speed tends to cause slurring and omission of

words. Proper pronunciation and enunciation is important.

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5. Give directions in logical order. People may become confused if they must go

back to previous information because you forgot to include an important point.

Get yourself organized before giving directions; then explain the activities in

the order in which they should be done.

6. Avoid giving too many directions at one time. Some people have pick-track

mind and can follow only one order at a time. An inexperienced person may

become confused when too many are given at once. If several directions

must be given to one person, you should put them in writing so that they may

be referred to if necessary. Written directions, including policies and

procedures, help ensure that all work is done properly and that nothing is

omitted.

7. Make certain that you directions are understood. Just asking whether people

understand is often not sufficient. Sometimes you will have ask question =s to

find out if they know exactly what you expect them to do. Let them each ask

question or explain how they are going to carry out your orders.

8. Always make sure that your directions are being followed. Nurse-leaders

must supervise those who give patient acre. No direction is complete until you

know what was done, how it was done, and how the patients feel about their

care.

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Your manner in giving directions is important

As a nurse, you must learn how to work and get along with people. The manner

in which you give directions and explain assignments will indicate to your co-workers

you attitude about them that they are never working for you. The kind of leadership you

give and the situation itself will determine to a great extent the manner in which you give

directions.

There are times when you will need to give a direct order or command. In case of

emergency or danger, when time is important, you are the only one who has the

necessary knowledge; therefore, you tell each person just what to do. Sometimes, in

order to control certain types of individuals --- such as the one who is lazy or indifferent,

or who refuses to follow accepted procedures --- you will find that the direct approach is

more effective than any other.

You may occasionally use an implied direction. When members of the group

have learned to work together efficiently and have gained more experience, you can

sometimes suggest the action that you want them to do. For example, you enter a

patient’s room while her care is being given and find it somewhat cooler than you

believe safe for the patient. You may say, “It seems rather chilly in here.” The

experienced worker well get the hint,

You may want to call for volunteers. This is a valuable method when a

disagreeable job needs to be done or when extra work needs to be taken care of. Do

not allow the group to depend upon one individual’s volunteering all the time. Also, you

will help strengthen cooperation if you offer to help whoever volunteers.

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The most common method of giving directions is to make them in the form of a

request. There are many different ways to word directions in this manner; for instance,

“will you...?” or “Let’s...” or “how about...?” This method encourages cooperation and

helps get more work done. It is effective with the person who is extremely “touchy” or

with one who is equal in rank. It will also work with people who are interested in their

jobs, or with the individual who is older than you are and who may, therefore, dislike

taking orders from you.

VI. Supervision Includes Observation

Observation is an important part of supervision it provides information about the

patient, the patient’s environment, the nursing staff and the care they give to the patient.

As a tool of management, the process of supervision makes use different,

although related, activities. Planning and organizing, teaching, and process of

communication have already been discussed. Now comes the follow-up, which is done

by observing the staff in action. This observation involves more than just inspection and

checking, although these are important. Observation, as noted before and as used here,

implied the acquisition of information through the use of all your senses including your

intuition, which is sometimes called the sixth sense. You should observe continuously

while you look, do, talk, listen, write, and read. The process of evaluation should be

carried on simultaneously with observation.

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Learn to see what you look at

Have you ever looked for a pencil, you bandage scissors, or a certain instrument

and been unable to locate it only to have it suddenly appear in front of you? It was there

all the time, and you probably looked at it many times during your search, yet you could

not see it. This can happen as you observe your staff. However, through conscious

effort, you can increase you ability to see. Here are some suggestions that may help

you learn to see what you look at, that is to recognize meaning in what you look at.

Have Some Idea of What to Look for Before You Begin Your Observation

In order to do this, you will need to use all the knowledge you have gained in

your entire classroom and clinical experience. Ask yourself continuously what and how;

for example:

1. What symptoms should I look for in this patient?

2. What safety measures should be used for this patient? Are they being used?

3. How should the patient‘s environment appear when his care has been

completed?

4. What is each person doing at this moment?

5. Is the nurse’s aide turning the patient often enough? What method is being

used?

6. Is the patient responding to nursing care in the expected way? If not, why

not?

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Be careful to look at every aspect of each patient’s case and environment; this

will include the care each is receiving and has already received. However, do not

concentrate on single details only and thus neglect to obtain an overall picture of the

patient’s care and response to care. Keep in mind other information that can be

obtained through what you see --- for example, what kind of sympathy is shown toward

the patient , or whether a worker might adapt the principles of a procedure to fit a

particular need of a patient, thereby indicating an understanding and appreciation of the

patient’s problems by the worker. Keep checking back on the questions you want

answered but do not limit yourself to that information only.

Consider Each Person as an Individual

When you observe individuals at work, you will need to compare the care they

are giving with what they are capable of giving. In like manner, you will need to consider

the attitudes, emotions, and differences of each. It is impossible to pour everyone into

the same way. Your understanding of them as individuals should give you more self-

confidence in your personality relations with them. Furthermore, a greater spirit of

cooperation follows when consideration is given to the personal desires, needs, and

abilities of each individual.

Try to be Objective about what you see

If ten people observe a certain incident and then try to describe it, there will

probably be ten different versions. Everyone will have a particular interpretation of the

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incident and will be sure that that version is correct. There are several reasons why it is

sometimes difficult to get a factual account of any incident.

First of all, we fail to be objective in our observation because our attitudes and

motives may cause us unconsciously to overlook or to exaggerate certain things. It is

not uncommon for us to see only what we want to see. It may be extremely difficult for

us to be entirely objective when observing someone we either like or dislike intensely.

Since what we believe we see is often controlled by our preconceived ideas, beliefs, or

emotions about the situation in general, we may generalize and the look for examples to

prove that we are correct. For example, if we believe that all teen-agers are juvenile

delinquents, we will see only those incidents that tend to support our belief. We will fail

either to look for or to recognize anything contrary to our belief.

Another reason for this lack of objectivity lies in the fact that our minds tend to

supply that part of the action that we did not see, thus making those facts we did

observe meaningful to us. For instance, as a nurse passes the door of a patient’s room,

she hears a noise and turns in time to see the patient pulling himself into a chair from a

kneeling position on the floor. Unless she is aware of the legal implication, she will

probably say that the patient fell out of bed. Yet, when she is asked, she will be unable

to say truthfully that she saw the actual fall. Her belief that he fell stems from the fact

that she filled in an action that might have caused the noise she heard and that would

have accounted for the position of the patient when she first saw him.

When we realized the importance of being objective in our observation, we will

also realize that we must obtain all the facts before we are justified in drawing any

conclusion. Assuming that something has happened or that something is true without

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first obtaining the substantiating evidence invalidates any conclusion based on those

assumptions. Conclusions should be made only after all the facts have been collected.

You must try to be accurate and objective in your observations of both your

patients and your staff. Try to obtain all the facts. For example. You should be careful

about believing that a person did not do a certain part of an assignment simply because

that person has been known to omit it in the past. On the other hand, you are not

justified in thinking that someone has completed certain work simply because that has

always been so in the past. You must have sufficient evidence before drawing any

conclusion. The fact that a person neglected on one day to tell you about the symptoms

of one of the patients does not justify your saying that this person usually fails to

observe symptoms accurately, forgets to report them, or, as is so often the remark if this

person is a nursing students, does not assume responsibility.

The knowledge that your attitudes and emotions are likely to color what you see

should make you especially careful in making observations. When you feel irritable and

tired, you are likely to pick up those incidents that provoke you; when you feel happy,

you will tend to overlook these same incidents.

Look for Relationships or Association between what you see and What the Overall

Situation Appears to be

Any incidents is made up of a number of separate actions, each of which could

have a number of different is made up of a number of separate from the total incidents.

Therefore, it is necessary not only to observe individuals steps of nursing care but also

to consider each step in relation to total care needed by the patient. Do not look for error

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only, but consider the entire performance of the worker. Seeing how all aspects of care

fit together will indicate, to some extent, the understanding that the worker has

concerning the needs of each patient. You should determine whether each part of the

care is correctly given, but you should also observe whether the proper sequence of

steps or procedures is used.

Be Interested in What You See

Interest helps you to be more complete and accurate in your observation of

details. This can be demonstrated in your ability to recognize people and remember

their names. If, at the time of an introduction, you were extremely interested in and

eager to meet someone, you will later be able to describe quite accurately and, if you

meet again, recognize that person. If, however, you were busy thinking of other things

and gave only superficial attention at the time of the introduction, you will find it

extremely difficult to remember specific details about the individual, because you did not

really see those details in the first place.

Interest in your patients and in the nursing care given by your staff will increase

your ability to see what they are doing, because you will tend to give greater attention to

the details of their work. Concentrating while consciously looking for details will also

help you see better. You can never allow yourself to become so engrossed in your own

work and problems that you look at, but are unable to see, the work and problems of

others.

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Learn to Listen

Perhaps the biggest obstacles to effective leadership lie in talking too much and

forgetting to listen. Learn to listen to what others are saying. This includes listening for

what is not said. People tend to omit ideas that make them uncomfortable or about

which they think they will be criticized. Group feeling is stimulated when each member

feels free to offer suggestions, knowing that you will give them thoughtful consideration.

Remember that your position as leader does not give you the right to do all the

planning, make all the suggestions, or issues only commands. Resentment is usually

the result of such autocratic leadership, and instead of welcoming your supervision, the

worker will send to avoid it, and you, whenever possible.

Some of the aspects of listening were discussed in the section on

communication. As a reminder, however, remember that you need to listen for the

“overtones” in a person’s conversation. It is not always what is said that counts. Listen

with your eyes. The tone or inflection of voice along with facial expressions and gesture

is important in giving meaning to the spoken words. Look at individuals while they are

speaking. Give them time to express themselves and indicate interest in what they are

saying, listen as they talk with the other workers or with their own patient. Ask yourself if

the information they are giving is correct, if they are displaying the proper understanding

of the patient and of the care the patient needs, and if they show an appreciation of their

patients’ problems.

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Cultivate your intuition

This sixth sense comes with experience. You get a certain feeling, nothing

definite, nothing that is the result of a logical thought process. It is the result of the

knowledge and understanding you have accumulated from you various experiences in

similar situations. While you cannot rely upon your intuition alone, you cannot ignore its

presence. Perhaps the thought occurs that you should check on how a member of your

staff is giving a certain part of a patient’s care. Do so; it could be important. Something

tells you that not all the pertinent information has been given about a certain situation;

keep searching until you are satisfied.

Observe continuously

Although you should observe the staff constantly, do not watch any one

individual too closely. Constant observation is not necessarily close observation. The

first gives workers a sense of confidence and security; the other indicates your lack of

confidents and trust in their ability to do their work. The purpose of observation is to

provide a source of information that you can use to guide, help, and encourage the staff

in their work. Observation is also necessary to determine the effectiveness of the

nursing care given.

Of course, good observation can be done only when you know what to look for

and how to see it. This means, as discussed previously, having an adequate knowledge

of the needs both your patients and of the groups, then evaluating what you see in order

to determine how well the needs of both are being met. This knowledge comes only

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through personal contract with your patient and with your co-workers, during which you

consciously make use of all the techniques of observation.

Observe as you Work with The Staff

It is generally unwise to stand by doing nothing except watching a person at

work. This method of observation is the one that has caused the general belief that

supervision is inspection. An opportune time to observe your staff members is during

the time, you can observe manual skills and ability to adapt steps of care to fit the

patient’s needs, as well as skill in communicating with the patient and the patient’s

family. Note whether the person attends to all the details of nursing care or omits some

that are not felt to be important. A worker’s attitude toward a patient may be manifested

in approach and manner toward the patient or in the way the care itself is given. You

should be able to see how the staff is progressing with their individual assignments their

correctness in following established procedures, and the cooperation they show toward

each other.

Observe During the Report

The repost that each person gives at the completion of an assignment is a good

source of information, not only about the patient and the patient’s care but also about

the attitudes and understanding of the person who gave that care . for example, when

you get a report, you find out if all the cares was given; at the same time. You can

determine the worker’s ability to follow directions and interest in details. If the person is

allowed to chart, still another source of information is available, for you may find

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indications of the kind of work this person does, whether hurried, slipshod, meticulous,

neat, and so on. The spelling and content of the charting will also give you some

information about how much accuracy interests and is considered important by the

worker.

Observe After All Care has Been Given

You can continue to gain information if you visit the patients after their care has

been completed. Suppose you enter the room of a patient who is suffering from heart

decompensation and is on strict bed rest. You see that the window shade is arranged

so that the morning sun shines in the patient’s face. The patient himself is sitting up on

the back rest, but the pillows are arranged so that his head is pushed forward onto his

chest and his shoulders are hunched forward. His arms are lying outside the bed

covers, which are pulled tightly across his chest, making it even more difficult for him to

breathe. In addition, the sheet and spread hang unevenly down one side. The bedside

table is pushed away from the bed. The water glass is half full of water that feels warm

and looks stale. The signal cord is tucked under the pillow in such way that the patient

would have to exert himself to find it.

Contrast that picture with one you observe as you enter another room. This

patient, a woman with far advance cancer, is also sitting up in bed. Body alignment is

good, with the head, neck, and shoulders well supported by pillows that are arranged

correctly. The patient’s hair is combed and tied with a bright ribbon. There is even a hint

of lipstick and rouge. The bed covers are neat and arranged to give ample movement of

the feet. The shades are fixed to give plenty of light and yet shut out any glare. On the

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over-the-bed table are fresh water, an open magazine, and a box of tissues. A paper

bag for soiled tissues is pinned within easy reach of the patient. The signal cord is

fastened so that the patient can reach it without turning. The tube from the retention

catheter has plenty of slack yet is so arranged that the fluid will drain easily into the

container.

It is obvious from these observations that you can get a great amount of

information about the kind of care given to these two patients. You should not, however,

render judgement only on what have seen. You must talk with the worker caring for the

first patient to determine whether any reason exists for the apparent poor care. You

should also ask yourself some critical questions about your methods of making

assignments and the amount of help given to the person who was assigned to care for

the patient. Perhaps her assignment was too large for her to complete, or she was

interrupted too many times, or she was too inexperienced to care for this very ill patient.

Furthermore, the person who left her patient looking well cared for must be encouraged

to continue the good work.

Whenever you are observing consider what you should learn about the

knowledge, understanding, attitudes, and manual skills of those who are giving the

nursing care. The mere ability to recognize and remember accurately all your

impressions have little value in itself. The real test is what you do with your observation

in order to help your co-workers reach the objectives of nursing care.

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VII. Supervision Includes Evaluation

Meaningful evaluation can be done only if specific goals have been selected,

performance standards have been developed, and accurate observations made. In

supervision the manager must employ evaluation throughout the work period as well as

during the final assessment.

Everyone needs feedback on what they do to get better at it. We fully expect our

nurses to hear and act on our evaluations of their strengths and areas for improvement;

this is no different for supervisors or administrators who are expected to grow.

Resistance to evaluation is often emotional, which is not to trivialize it. If

people aren't feeling good, nothing gets accomplished. The solutions, then, need to

recognize this reality. The challenge is to lower anxiety and give people lots of chances

to talk about the feelings.

Leadership is crucial. Sometimes just having somebody say "We're going to do

this" is very helpful. At least it gets rid of uncertainty which feeds anxiety. If the head is

not fully behind the evaluation process, the process is doomed from the outset.

Accountability is a professional obligation. Research shows that people are

willing to be accountable when the process is thorough and fair. The approaches to

evaluation are legion. A whole industry has sprung up of people selling different

methods, instruments, videotapes, and workshops. Virtually every approach has

something to offer, but no one approach can simply be bought off the shelf and applied

to an organization. It is best that you learn as much as you can about what's available

and to then create your own eclectic process, drawing on the best parts of what you

learn. Despite the apparent complexities, the goal is simple: making sure that people —

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all staff members in the organization— get the feedback they need to grow. Keeping

sight of this goal will guide you through the maze of possible methods.

VIII. Statement of Summary and Conclusion

Definition of supervision for nursing: the provision of monitoring, guidance, and

feedback on matters personal, professional and educational development in the care of

patients. This would include the ability to anticipate a nurse’s strengths and weaknesses

in particular clinical situations in order to maximize patient safety.

The supervision relationship is probably the single most important factor for the

effectiveness of supervision, more important than the supervisory methods used.

Feedback is essential and must be clear. It is important that the subordinate has some

control over and input into the supervisory process. Finding sufficient time for

supervision can be a problem. Subordinates behaviors and attitudes towards

supervision require more investigation; some behaviour is detrimental both to patient

care and learning.

There is evidence that supervision has a positive effect on patient outcome and

that lack of supervision is harmful for patients. The quality of the relationship between

supervisor and subordinate is probably the single most important factor for effective

supervision. The ultimate purpose of supervision, whether stated or implied, is to

improve patient/client care/experience. Therefore, improvements in outcomes for

patients/clients are one major test of effective supervision.

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