Price A M, Chalker M
Royal Free Hospital, London, UK.
Intensive Crit Care Nurs. 2000 Feb;16(1):51-5. doi: 10.1054/iccn.1999.1475.
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.
1991年，护理行业开始大力推行反思性实践理念，尽管几乎没有证据表明反思性实践能改善护理服务（伯纳 1991；亨特 1993）。纽汉姆总医院重症监护病房针对护士撰写反思日志的经历开展了一项小型定性研究（A·普赖斯 1995）。这凸显了在引入反思性实践时提供明确初始指导和支持的必要性。研究还表明该病房内部对反思缺乏了解。在此期间，一群对发展临床督导作为员工支持方法感兴趣的护士组成了小组。该小组在查阅文献后采用了科纳（1994）对临床督导的定义，明确这涉及对实践的反思。约翰斯（1993）的结构化反思模型经过修订，用于促进对各种情况的深入分析，并且鼓励小组内撰写日志。于是启动了一个持续的小组临床督导过程，最初在一位经验丰富的协调人的帮助下进行。基于这一经验，该小组制定了重症监护病房临床督导的实施策略并付诸行动。对所经历的进展和问题进行思考后得出结论，持续的员工积极性和投入以及充足的时间对于临床督导的实施至关重要。
