Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. A number of factors have been identified which may have an impact on this, including fears, beliefs and support. Bandura's Social Learning Theory has been used to gain an understanding of the association between these factors, and insights have been gained from the management training literature about the potential to buffer the transfer process. This study investigated the potential of clinical supervision as a method of facilitating transfer. The study compared a three day communication skills training workshop plus an intensive 4 week course of clinical supervision with training alone. 61 Clinical Nurse Specialists were randomised to receiving 12 hours of clinical supervision immediately after a 3-day communication skills training course. Assessments were carried out before the course, immediately after the supervision period and 4 months later. Three real patient encounters were recorded at each time point to assess the nurses' use of skills, their ability to identify concerns and their ability to respond to cues. These were then compared to simulated interviews conducted at the workshop and to measures of self-efficacy, outcome expectancy and burnout. Supervision was found to have a small but significant effect on nurses' ability to transfer skills to the workplace. The nurses in the experimental group showed improvements in 4 of the 18 skills areas associated with significant improvements in self-efficacy, and were found to be more willing to identify concerns of an emotional nature. Conversely the control group showed no improvement in use of skills and identified fewer psychological concerns. Furthermore, it was found that training had a negative effect on burnout. Nurses in the control group experienced increases in both emotional exhaustion and depersonalisation as measured by the Maslach Burnout Inventory. Supervision appeared to have a protective effect against this. The study highlighted the gap between competence and performance in the use of communication skills with real patients. It showed the potential of clinical supervision as a forum to facilitate the process of transfer, and raised challenges about negative consequences of training if support is not offered in the crucial transfer phase.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:497488 |
| Date | January 2001 |
| Creators | Heaven, Catherine Margaret |
| Publisher | University of Manchester |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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