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What are the views of frontline practitioners in regard to safeguarding supervision?

18 September 2020

Author: Ann Guindi

Email: [email protected]

Research summary

  • This study explores the views of community nurses and their perceptions of safeguarding supervision. 
  • Questions were formulated to address possible factors deemed helpful/unhelpful in safeguarding supervision carried out by Guindi et al (2019), which the author wished to explore further.
  • Thirty-seven frontline nurses from a community NHS foundation trust completed an online survey tool, Qualtrics. 
  • Ethics approval was granted from both the trust, Health Research Authority and the university. 
  • Results from this small-scale study suggest that the model of safeguarding supervision was not important, but the preferred mode was a combination of one-to-one and group. 
  • The factors perceived as most important were feeling safe or having a safe environment, experienced practitioners and critical reflection. 
  • The ‘qualities’ of the supervisor deemed most important were prior training in supervision skills. Leadership skills were not seen as important. Most felt that the supervisor should be from the same professional background.   

Abstract 

This study explores the views of community nurses and their perceptions of safeguarding supervision. Thirty-seven frontline nurses from a Community NHS foundation trust completed an online survey tool ‘Qualtrics’. Ethics approval was granted from both the trust, Health Research Authority and the University. Results from this small-scale study suggest that the model of safeguarding supervision was not important in the process, the preferred mode was a combination of one to one and group. The factors perceived as most important were feeling safe/safe environment, experienced practitioner and critical reflection. The ‘qualities’ of the supervisor deemed most important was prior training in supervision skills, leadership skills were not deemed as important. Most felt that the supervisor should be from the same professional background.     

Key Words: safeguarding supervision, frontline nurses, model and mode of supervision, qualities of the supervisor. 


Introduction

This paper is a follow-up to the literature review carried out by Guindi et al (2019), which highlighted the lack of empirical evidence on safeguarding supervision from the perspective of frontline nursing practitioners in the community working with children. 

Safeguarding supervision has been in practice for over 10 years among community practitioners (CPs), namely health visitors and school nurses, looked after children (LAC) nurses and family nurses. The first paper on this subject area was written by Green Lister and Crisp in 2005. However, since then only a handful of papers have been written on this subject: Hall, 2007; White, 2008; Botham, 2013; Hackett, 2013; Jarrett and Barlow, 2014; Rooke, 2015; Smikle, 2017; Warren, 2018 and Little et al, 2018. 

There is recognition that supervision practice must be evaluated from the point of outcomes on its effectiveness in safeguarding children (Karpetis, 2019). The findings from this small-scale study will look at safeguarding supervision in the context of frontline community practitioners. It will explore and build on the suggested factors identified in the literature review by Guindi et al (2019) about what practitioners find helpful and unhelpful in the process. 

Safeguarding practice is continually evolving following the lessons learnt when things go wrong in practice, resulting in the death of a child. High-profile cases driven by the media has put pressure on the government to act and respond by carrying out inquiries and making recommendations to prevent further deaths (Laming, 2009; 2003).

Professor Eileen Munro’s first review into child protection spoke about the importance of a systems approach and the need to be child-focused in the work of safeguarding children (Munro, 2010). This child-focused approach was supported by the Office for Standards in Education, Children’s Services and Skills (Ofsted) in their thematic review report ‘The voice of the child: learning lessons from serious case reviews’ (Ofsted, 2011). 

Ofsted (2011: 15) suggested that ‘there was a difference between hearing the voice of the child and the actions that followed’. In that this was not always followed in practice. ‘Professional supervision is a core mechanism for helping social workers to critically reflect on the understanding they are forming with a family’ (Munro, 2011a: 53). This interim report was followed by Munro’s third and final report (Munro, 2011b). In her final report, Munro shifts her thinking in recognising that GPs and health visitors (HVs) are well placed to identify problems early. 


Nurses’ responsibility for supervision

Nearly 25 years ago, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (now the NMC) brought out guidelines on supervision (UKCC, 1996). The Care Quality Commission speaks about roles and responsibilities in safeguarding children and adults (CQC, 2015). Everyone has a responsibility to safeguard children (Department for Education, 2018). 

Nurses should have access to safeguarding supervision in order to stay professionally up to date with practices and recognise children who are at risk of abuse or neglect (Royal College of Nursing, 2019). 

Study aim 

This study will explore the views of community nurses in order to get their perspective on safeguarding supervision and examine some of the suggested factors found in the literature pertaining to community nurses (Green Lister and Crisp, 2005; Hall, 2007; White, 2008; Botham, 2013; Hackett, 2013; Jarrett and Barlow, 2014; Rooke, 2015; Smikle, 2017; Warren, 2018 and Little et al, 2018). 

Research questions 

This study selected three questions centred around factors which are of interest to the author. A fourth question explores the other factors found in the literature review carried out by Guindi et al (2019).

  1. What are the views of community nurses (HVs, school nurses, family nurses and nurses working with children in care) towards the application of a safeguarding supervision model?
  2. How do community nurses perceive mode (one-to-one, group, peer, or combination) of safeguarding supervision within the process?
  3. What are the thoughts of community nurses on whether a safeguarding supervisor should have specific ‘qualities’ such as leadership skills/supervision training prior to taking up the role of supervisor?
  4. What other factors do community nurses feel are helpful/unhelpful in safeguarding supervision?

Method

Strategy and design

An online survey was designed to gather both qualitative and quantitative information consisting of 14 questions. The first three questions consisted of gaining consent, identifying role and length qualified. The remaining questions were designed around the themes identified in the authors literature review (Guindi et al, 2019). The author asked specific qualitative questions around model, mode and qualities of the supervisor in order to answer the research questions. This generated meaning behind the numerical data.  

Data was gathered through a secure online project management system known as Qualtrics. All respondents were assigned a number and referred to only in this way. Entry into the system was password-protected and only known to the author. Data was accessed from the researcher’s laptop, which was also password protected. 

Ethics

Permissions to carry out the research was gained from the trust facilitated through the research and development team, with a letter of access granted. Approval was gained from the Health Research Authority (HRA) along with the university.

Population

The survey was started by 47 respondents. However, only 37 HVs, school nurses, family nurses, LAC nurses, and the nurses from the pilot were kept. The rationale behind the 10 being discarded was that they either did not complete the survey or they did not meet the criteria for inclusion (administrators and nursery nurses). The inclusion criteria consisted of those nurses working directly with children under 18 years in a home-visiting capacity. It excluded adult nurses working with families, sexual health nurses and learning disability/mental health nurses. Most of the sample consisted of HVs (n=25, 67.6%); there were fewer school nurses (n=5, 13.5%), LAC nurses (n=3, 8.1%), family nurses(n=2, 5.4%), and pilot HVs (n=2, 5.4%). Experience in practice ranged from newly qualified up to 41 years, with an average of 14.11 years (SD=11.915).

Procedures

The workforce were informed that the research was being conducted via a community bulletin and team meetings. The online survey was planned to remain open for one month. However, after two weeks the response rate was poor with only 30 employees having responded. Two follow-up email reminders were sent, and the questionnaire was extended an additional week, which resulted in another 17 responses.


Results

Models of safeguarding supervision

Respondents were asked to score their familiarity of a safeguarding supervision model out of 100%. Figure 1 shows that most respondents were most familiar with the Signs of Safety (SoS) model of supervision (n=29, 78.4%), the reflective model (n=26, 70.3%), and the Family Partnership Model (FPM) (n=18, 48.4%). There were 11 respondents familiar with the resilience model (29.7%), seven familiar with the restorative supervision model (18.9%), six familiar with the Brearley model (16.2%), five with the 4x4x4 model of integrated supervision (13.5%), and four familiar with the Peskin model (10.8%).


Figure 1. Sample distribution rated out of 100 per cent familiarity with each model of safeguarding supervision (n=37)

When asked to expand on their answer, 25 respondents gave additional information, with 13 giving a rationale for choosing their preferred model for supervision. These were primarily having a working knowledge of the model and it being aligned with social care. 

Modes of safeguarding supervision

Respondents were asked about their preferred mode of supervision, and 35 out of 37 replied. Figure 2 shows that primarily the respondents preferred a combination of one-to-one supervision, group supervision, and peer supervision (n=15, 40.5%). One in three opted for one-to-one supervision (n=12, 32.4%), and one in five opted for group supervision (n=7, 18.9%). None of the respondents opted for peer supervision, and three respondents (8.1%) did not reveal their preference as they were newly qualified and had not yet received supervision. The mean was 2.49 (SD=1.36). The findings were not significant.

Figure 2. Sample distribution by preferred mode of supervision (n=34)

Twenty-seven respondents expanded on this answer which included both advantages and disadvantages of each mode. A combination of both one-to-one and group supervision was given as the most effective way to safeguard children.


Qualities of the supervisor

Professional background of supervisor

Thirty-four of 37 responded to this question: 24 respondents (64.9%) reported that it was important to them to have a safeguarding supervisor who comes from the same profession as them. However, five respondents (13.5%) were unsure, another five (13.5%) indicated that this was not important. Three (8.1%) did not disclose this information. 

When asked to expand on their answer, 24 responded. Of these, 19 wanted someone who understood their role but did not specify whether this had the same meaning as having someone from the same profession. Two spoke in general terms with no clear rationale for their decisions. Two respondents would be happy with someone from another profession being their supervisor. 

Training and credibility of the supervisor

Of 34 respondents (89.2%) who answered this question, 26 (78.8%) thought that a safeguarding supervisor should have a qualification in safeguarding supervision before undertaking their role. Twenty respondents expanded on this question when asked. Views included having perceived confidence and credibility in the supervisor gained through this specific training and knowledge.

Out of 32 respondents, 21 did not think that a safeguarding supervisor needed to have undertaken a leadership course prior to acting as a supervisor.

Other factors important to the supervision process

The most important factor in safeguarding supervision on a scale of 0 to 100% of importance was feeling safe/a safe environment followed by an experienced practitioner and being allowed the time and space to critically reflect on one’s own practice (see Table 1). The least important factor was the ability to apply heory in practice and the model of supervision used. Eight respondents (21.6%) did not disclose this information.

Table 1. Descriptive statistics values of the eight factors evaluated by their importance to effective supervision (0 = least important, 100 = most important)

Discussion

This community trust uses the SoS model delivered through a combination of both one-to-one and group supervision. The findings reflect that this trust is most familiar with the SoS model, as this was the model that they worked with and was aligned with social care. However, model of supervision was ranked lowest in importance out of all the factors. The second most familiar was the reflective model. Reflection in nursing is well embedded in practice and has been recognised within clinical supervision since 1995 when the United Kingdom Central Council (UKCC), now known as the Nursing and Midwifery Council (NMC), published definitive guidelines for nurses and health visitors (UKCC, 1996).

The literature review conducted by Guindi et al (2019) suggested that practitioners wanted a national model to be introduced and perceived this as beneficial for auditing purposes. This was called for by both Hall (2007) and Rowse (2009). Botham (2013) echoes this in her literature review when she names the absence of an accepted ‘model’ as a theme. She writes that ‘analysis of the literature indicates there is no definitive definition or working model for safeguarding children supervision for health visiting professionals and school nurses’. Therefore, it is difficult to measure how effective safeguarding supervision is as there is no model that is recommended, recognised, or accepted for practice on the national level (Hall, 2008). Wallbank and Wonnacott (2015) also call for a nationally recognised safeguarding supervision model, which they feel ‘would be welcomed by practitioners and safeguarding boards alike’. However, based on the findings in this survey, the model of safeguarding supervision is of little consequence when it comes to the effectiveness of safeguarding supervision. 


Mode of safeguarding supervision

Most frontline practitioners (40.5%) preferred a combination of supervision modes. This may suggest that one-to-one, group or peer supervision are not enough to meet the needs of practitioners. It is important to acknowledge that respondents found both modes to have benefits. This was reflected in some of the responses. Both one-to-one and group supervision can meet the needs of supervisees in different ways. 

These views were also reflected in the literature review and wider research (Guindi et al, 2019). Rooke (2015) found that there were advantages to receiving both types of supervision within the health visiting practice: ‘Individual clinical or restorative supervision reported to be more informal and useful for dealing with the emotional elements of the role, whereas child protection group supervision reported to be beneficial for accountability, outcomes and actions.’

One-to-one safeguarding supervision was the respondents’ second most-preferred mode of supervision (n=12, 32.4%). The advantages of one-to-one supervision were evident in the responses given. ‘One-to-one is required in complex cases’ (Respondent 4). ‘One-to-one gives me protected time’ (Respondent 14). Others argue that one-to-one supervision is problematic as it may not hold people accountable (Butterworth and Fougier, 1992). Davis and Cockayne (2005) suggest that ‘it carries a risk of collusion and provides a weak means of addressing poor practice’. This suggests that a group setting may be better for holding members accountable. One-to-one supervision can provide consistency, predictability, and regularity and is likely to facilitate the development of a positive relationship. 

Group supervision was rated lowest in the survey responses (18.9%), although there were some perceived advantages. Tripartite supervision was also valued and used within the FPM facilitating learning. This is supported by others, but it does depend on skill, commitment and attendance, and it can be more valuable than one-to-one supervision (Bond and Holland, 2010). 

The literature review conducted by Guindi et al (2019) suggests that there were both helpful and unhelpful factors in safeguarding supervision. There were also factors that facilitated the supervisory relationship. The author wanted to see if these were reflected in the sample population. The three highest-ranking factors were feeling safe/safe environment, experienced practitioner, and critical reflection.

It is uncertain what practitioners mean by the term ‘experienced practitioner’, and this needs further exploration to define. According to Green Lister and Crisp (2005), ‘there were particular concerns from HVs that supervision should be provided by someone with expertise in child protection’. The concept of an expert practitioner was again raised by Hall (2007). Hall’s findings showed that practitioners wanted ‘an expert practitioner who could listen to their concerns and provide feedback both positive and negative’. 

Botham (2013) links experienced practitioners to feeling safe: ‘Supervisees need to feel safe to be able to function properly, preferably with an experienced colleague who will challenge them and aid their decision-making.’ This may suggest that a less experienced supervising practitioner may not have the confidence or knowledge to challenge their supervisees. There does appear to be a link between experienced practitioners and ensuring safe and effective practice. Rooke (2015) suggested that ‘gaining regular feedback on casework and debriefing sessions with an experienced practitioner, was reported to be of benefit to the delivery of safe and effective practice’. 

The concept of being critical in practice was first raised by Green Lister and Crisp (2005) They stated: ‘The ability to critically analyse and discuss ones’ own practice requires trusting relationships between participants.’ This finding was also supported by Botham (2013). Jarrett and Barlow (2014) found that family nurses are ‘encouraged to be challenged and reflect on their practice, and as a result of increasing awareness were able to examine and re-evaluate the clinical decision that they made’.

Implications and recommendations

This study was a relatively small-scale study with only 37 respondents. The findings cannot be generalised to the entire population of frontline practitioners as the findings only covered a single community NHS foundation trust. 

  • Model of supervision does not appear to be of importance to practitioners, but critical reflection is important for learning.
  • The preferred mode of supervision suggests a combination of both one-to-one and group but needs further evidence. 
  • Qualities of a supervisor still needs further exploration, but additional training in supervision skills is deemed important. 
  • Experienced practitioner was a key factor in safeguarding supervision; it would be of value to explore this concept further. 
  • Providing a safe environment/feeling safe was important in supervision; how this is achieved, and whether its absence has an impact on the child remains unknown.

Conclusion

Direction from previous government reports and independent inquiries such as the Munro reports (2010, 2011a; 2011b) and Ofsted (2011) suggest that supervision should be child-focused in order to hear the ‘voice of the child’. The question now needs to be asked: how to achieve this through supervision? There was some suggestion in this study that the SoS model is best placed to hear the ‘voice of the child’. But model of supervision applied was ranked the least important factor. 

The results from this study do not bring any insights into whether any one factor is more important than any other when it comes to hearing the child’s perspective within safeguarding supervision, and this is where the focus needs to lie if we are to understand the impact of safeguarding supervision in protecting children from harm. 

The study was carried out within a single trust only but seems to suggest that there are factors deemed more important in supervision for practitioners, such as being supervised by an experienced practitioner, feeling safe/a safe environment, and being allowed the time to critically reflect on their practice. 

However, there are still several issues that need to be explored further regarding the model, mode and regularity of safeguarding supervision received to explore whether they result in better outcomes for children. 

It is still unclear whether having a recognised qualification in safeguarding supervision skills makes any difference in achieving positive outcomes for children. But leadership training was not thought to be necessary for the role of supervisor. 

Ann Guindi is a PhD student at Canterbury Christ Church University. 


References

Bond M, Holland S. (2010) Skills of clinical supervision for nurses: a practical guide for supervisees, clinical supervisors and managers (2nd edition). Maidenhead: Open University Press.

Botham J. (2013) What constitutes safeguarding children supervision for health visitors and school nurses? Community Practitioner 86(3): 28-34.

Butterworth J, Faugier J. (1992) Clinical supervision and mentorship in nursing. Chapman Hall: London.

Care Quality Commission. (2015) Statement on CQC’s roles and responsibilities for safeguarding children and adults. See: bit.ly/CQC_2015_safeguarding_statement (accessed 18 August 2020).

Davis G, Cockayne D. (2005) Peer support in child protection. Journal of Community Nursing 19(10): 18-21.

Department for Education (2018) Working together to safeguard children. HM Government: London.  

Green Lister P, Crisp BR. (2005) Clinical supervision in child protection for nurses. Child Abuse Review 14(1): 57-72.

Hackett A. (2013) The role of the school nurse in child protection. Community Practitioner 86(12): 26-9.

Hall C. (2007) Health visitors' and school nurses' perspectives on child protection supervision. Community Practitioner 80(10): 26-31.

Guindi A, Hassett A, Callanan M. (2019) Safeguarding supervision: on the frontline. Community Practitioner 92(9): 45-7.

Jarrett P, Barlow J. (2014) Clinical supervision in the provision of intensive home visiting by health visitors. Community Practitioner 87(2): 32-36.

Karpetis G. (2019) Clinical supervision in child protection practice: a review of the literature. Trauma, Violence and Abuse (online). See: pubmed.ncbi.nlm.nih.gov/31522625 (accessed 21 September 2020).

Laming L. (2009) The protection of children in England: a progress report – Lord Laming Report. TSO: London.

Laming L. (2003) The Victoria Climbié Inquiry. HMSO: London.

Little M, Baker T, Jinks AM. (2018) A qualitative evaluation of community nurses' experiences of child safeguarding supervision. Child Abuse Review 27(2): 150-7.

Munro E. (2010) The Munro review of child protection part one: a systems analysis. See: bit.ly/Munro_systems_analysis (accessed 17 August 2020).

Munro E. (2011a) The Munro review interim report: the child’s journey. See: bit.ly/Munro_child_journey (accessed 17 August 2020).

Munro E. (2011b) The Munro review of child protection: final report: a child-centred system. See: bit.ly/Munro_final_report (accessed 17 August 2020). 

Rooke J. (2015) Exploring the support mechanisms health visitors use in safeguarding and child protection practice. Community Practitioner 88(10): 42-5.

Rowse V. (2009) Support needs of children’s nurses involved in child protection cases. Journal of Nursing Management 17(6): 659-66.

Royal College of Nursing. (2019) Safeguarding children and young people: roles and competencies for healthcare staff. RCN: London.

Smikle M. (2017) Preparing supervisors to provide safeguarding supervision for healthcare staff. Nursing Management 24(8): 34-7.

Ofsted. (2011). The voice of the child: learning lessons from serious case reviews: See: bit.ly/Ofsted_2011_voice_of_the_child (accessed 18 August 2020).

UKCC (1996). Position statement on clinical supervision for nursing and health visiting. UKCC: London.

Wallbank S, Wonnacott J. (2015) The model of restorative supervision for use within safeguarding. Community Practitioner 88(5): 41-5.

Warren L. (2018) Role of leadership behaviours in safeguarding supervision: a literature review. Primary Health Care 28(1): 31-6.

White J. (2008) A model of child protection supervision for school health practitioners. Community Practitioner 81(5): 23-7.

 

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