BUILDING ON STRENGTHS;

The Development and Testing of a Solution Focused Approach to Clinical Supervision.

Supervisor: Prof Ken Walsh, Professor of Nursing ISLHD/UOW Trainees: Karlie Royston Camillia Spearing

Shoalhaven District Memorial Hospital

Located South Coast NSW Departments: ICU, ED, Medical, Surgical, Renal, Rehab, Acute

Stroke, Maternity, Paedatirics, Day Stay, Operating Rooms. Beds: 177

Facilities: CT, X-ray, Sonographer. Allied Health: Social Work, Speech therapy, Occupational

therapy, Physiotherapy, Case Workers, Dietician, Acute pain service, Chronic & complex care teams, Discharge Support Services, Ambulatory care, Infection Control teams.

Nursing Staff: Registered Nurses, Clinical Nurse Specialists, Clinical Nurse Educators, Clinical Nurse Consultants, Clinical Midwifery Specialists, Midwives, New Graduate Nurses, Enrolled Nurses, Assistant Nurses.

PROJECT AIMSDevelop supervision skills in giving and receiving

feedback (for both high performance and below par performance).

Improve appraisal and assessment skills.Enhance interpersonal skills and the ability for self

reflection (for both the supervisor and supervisee).Sustain development through co-facilitation, follow-ups

for skills consolidation and ongoing action learning.

OBJECTIVE OF PROJECTAt completion of program, the health service will have a solution focused clinical supervision workshop to meet the needs of staff supervising undergraduates, new graduates, and experienced staff.

To have the potential to expand the program to other categories of staff such as interns, junior doctors and allied health.

PROGRAM DEVELOPMENTStakeholder engagement focus groups of claims, concerns

and issues related to supervision skills.Development of solution focused clinical supervision

resources.Development of Clinical supervision case senario’s Conducting of co-facilitation workshops for clinical skills

development.Workshop evaluation Follow- up sessions for skills and consolidation with action

learning.Post implementation evaluation.Report.

PROBLEM FOCUSED

The Past

What’s wrong?

Blame

Control

The experts know best

Deficits

Complications

Definitions

SOLUTION FOCUSED

Actions

What’s working

Influence

Collaboration

Progress

Simplicity

The Future

Resources

Principles of Solution-focused Approaches

• Work with the person rather than the problem• Look for resources/strengths rather than deficits• Nothing happens by chance something makes it happen• Find out what makes good things happen and do more of it• Explore possible and preferred futures• Explore what is already contributing to these futures• Use creativity and imagination to imagine a better future and

work towards it• Treat the person as the expert in their own life (Duncan et al, 2007)

The Solution Focused Shared Humanity

Framework Understanding PossibilityCompassionate Action

Understanding Understanding self and other

PsychodynamicsNeurobiological (SCARF) – “Towards” and “Away”

states Engagement (Puzzling)Motivation Listening for understanding and possibility Asking good questions The solution focused approach: Looking for what

works and strengthsSolution focused questions

Possibility Exploring and Developing Possibility

Permission and placement Identifying goals Solution Focused Feedback for good performance Solution Focused Feedback for below par

performanceMentoring and coaching “IGROW” model The assertive option

Compassionate Action Values based actionsMoving from thinking to action Making it positive – build self esteem and self

efficacyScaling questions Build in evaluation / support reflection and

feedback

SCARF activitySpend a couple of minutes reading the handout SCARF

and YOU. Think about which domain is your driver and how that

might influence your behaviour. In small groups discuss a recent example of a SCARF

domain being trigger to engage or disengage you or someone else.

As a class discuss scenarios (handout) with SCARF in mind. Status , Certainty , Autonomy, Relatedness, Fairness

(The five domains activate with the primary reward or primary threat circuitry of the brain) (Rock, 2006)

Small group interaction activity

In threes: one person tells a story, one person listens and the other observes.

The listener then summarise the story to show empathy and an understanding of content, context, emotion and meaning.

Observer and present give feedback. Swap roles and try again. For the purposes of this exercise do not ask questions.

EXAMPLES OF “SOLUTION FOCUSED” QUESTIONS IN THE

WORKPLACEWhat changes have you already noticed?How would you know things were better…?Are there times when you already …? If you go to bed tonight and a miracle happens ... How

would things be different? Tell me about those times when this problem doesn’t occur.

How do you get that to happen?Does that already happen at times?What will you have to do to make that happen?What will have to happen for more of that to happen?

16

EXAMPLES OF “SOLUTION FOCUSED” QUESTIONS IN THE

WORKPLACE What could others do to help you? How have you dealt with ……..in the past? When things were better a while ago what was different then? How come things aren’t worse – what have you done to stop

things from getting worse? On a scale of 1-10 with one being …and 10 being …tell me…  

(Walsh, 2006)

Some Participant Feedback

There was loads of information on helping transitioning nurses in their practice development and my own development.

I would like to see it run again so others could benefit and improve work place culture.

The examples were appropriate and connected well to the theory. The research based framework applied to clinical situations. The plan for follow up interactions to see how we are applying what has been learned is a good idea.

Practicing techniques in scenario situations, behaviour is learned and can be changed, most people are good.

Evaluation of Solution Focused Component

Selected ReferencesDuncan, L. Ghul, R. Mousley, S. 2007. Creating Positive Futures. BT

Press, London. Green, J and Grant, A. 2003. Solution Focused Coaching. Pearson,

Edinburgh.Jackson, P. and McKergow, M. 2001. Harry Enfield, Hamlet and the

Solutions Focus, Organisations and People 8, (1): 26 - 31

Rock, D. Quiet Leadership: Six steps for transforming performance at work. Harper, New York.

Walsh, K Walsh, K. Moss, C. and FitzGerald, M 2006. Solution Focused Approaches and their relevance to Practice Development. Practice Development in Health Care 5 (3): 145-155.

QUESTIONS ??????