Ryu Hosu, Buus Niels, Naccarella Lucio, Zarb Lauren, Hamilton Bridget
Centre for Mental Health Nursing, Department of Nursing, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.
J Adv Nurs. 2024 Aug 14. doi: 10.1111/jan.16390.
The aim of this review is to identify and map the evidence available on the factors that influence the implementation of clinical supervision for nurses.
The scoping review was conducted and reported following the JBI methodology for scoping reviews.
Searches were conducted on MEDLINE, PsycINFO, and CINAHL databases on 28 March 2023.
A total of 1398 studies were imported into Covidence for screening. Researchers screened the papers according to the inclusion criteria. Empirical studies in English focusing on the implementation of clinical supervision for nurses were included, without year restrictions. Data from 16 studies were extracted and organized according to the constructs within the Consolidated Framework for Implementation Research (CFIR) domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process.
When compared with the CFIR constructs, it was found that the influence of the outer setting on implementation was less explored in the literature. Most of the reviewed data highlighted recurring factors, particularly logistical challenges of nursing work such as shift work and lack of control over work time. Organizational culture and managerial support were also identified as significant factors in the implementation. Another significant challenge in implementation was the variety in clinical supervision's design, purpose, and application, despite sharing the same label, leading to questions about whether studies are implementing the same practice.
Policy documents should clearly define both the design and purpose of clinical supervision, beyond just its conceptual definition. Greater emphasis on equitable implementation of clinical supervision is necessary to prevent perpetuating existing inequalities. We conclude that implementation of such complex interventions is not linear, and the implementation strategies need to align with expected implementation challenges.
The advantage of using the implementation framework lies not only in observing what exists as a form of evidence but also in identifying what is underdeveloped. Healthcare services and policy developers can utilize our review to recognize and address potential challenges in introducing, modifying, scaling up, or sustaining their clinical supervision implementation.
No patient or public contribution.
本综述的目的是识别并梳理有关影响护士临床督导实施因素的现有证据。
按照循证卫生保健国际协作组织（JBI）的范围综述方法开展并报告本范围综述。
于2023年3月28日在MEDLINE、心理学文摘数据库（PsycINFO）和护理学与健康领域数据库（CINAHL）进行检索。
共1398项研究被导入到Covidence软件中进行筛选。研究人员根据纳入标准对论文进行筛选。纳入以英文撰写的、聚焦于护士临床督导实施的实证研究，无年份限制。从16项研究中提取数据，并根据实施研究综合框架（CFIR）领域内的构念进行整理：干预特征、外部环境、内部环境、个体特征和过程。
与CFIR构念相比，发现文献中对外部环境对实施的影响探讨较少。大多数综述数据突出了反复出现的因素，特别是护理工作的后勤挑战，如轮班工作和对工作时间缺乏控制。组织文化和管理支持也被确定为实施中的重要因素。实施中的另一个重大挑战是，尽管都称为临床督导，但其设计、目的和应用存在差异，这引发了关于各项研究是否在实施相同实践的疑问。
政策文件不仅应明确临床督导的概念定义，还应明确其设计和目的。有必要更加强调临床督导的公平实施，以防止现有不平等现象持续存在。我们得出结论，此类复杂干预措施的实施并非线性的，实施策略需要与预期的实施挑战相匹配。
使用实施框架的优势不仅在于观察作为一种证据形式存在的内容，还在于识别尚未充分发展的内容。医疗服务和政策制定者可以利用我们的综述来认识和应对在引入、修改、扩大规模或维持其临床督导实施过程中的潜在挑战。
无患者或公众参与。
