Repositioning practice: a discourse analysis of clinical supervision as part of implementing a psychosocial intervention in cancer care

Research Doctorate - Doctor of Philosophy (PhD)This thesis by publication describes a study that used discourse analysis to explore clinical supervision sessions between supervisors and health professionals trained to deliver a psychosocial intervention for a large multi-site randomised control trial. The research questions asked: Does clinical supervision facilitate changes for Health Professionals trained to deliver a psychosocial Intervention? What influence does clinical supervision have on the discourses of Health Professionals and their practice? What might this reveal about change in practice and barriers/enablers to such changes? A systematic review of the barriers to psychosocial care revealed that Health Professionals reported organisational, cultural and individual clinician-related barriers. Clinical supervision is recommended to support Health Professionals in overcoming these barriers. Whilst a review of the clinical supervision literature explored confusion about expectation and the quantifiable outcomes of clinical supervision, there is evidence that multidisciplinary, group clinical supervision provides a forum for sharing of knowledge and generation of shared understandings of healthcare. The participants for the study were thirty Health Professionals (23 nurses, four physio therapists, two radiation therapists and one occupational therapist) and three clinical supervisors who took part in 96 clinical supervision sessions. Discourse analysis was used to critically examine seventeen audio recorded sessions of multidisciplinary, group format clinical supervision. Discourse mapping was used as a vehicle to explore discursive constructions in the data. The method of data collection and analysis represent novel approaches to exploring clinical supervision and its impact on the process of practice change. Findings showed that clinical supervision facilitated non-linear changes in the clinical practice of Health Professionals trained to deliver a new psychosocial Intervention. Changes included using discourse within the clinical supervision sessions to resist the systemic, organisational, cultural and personal barriers that presented themselves as part of delivering a new psychosocial Intervention. Clinical supervision provided a forum for sharing stories that were used to construct new meanings and reposition the Health Professionals within the experience of delivering psychosocial care in the context of adult cancer care. Health Professionals’ language was used to challenge, or accommodate tensions that were seen to govern the behaviours and language used by Health Professionals. Their discourses illustrated a fragility and potential for change. Discourses within supervision negotiated ways of practicing that may accommodate the tensions allowing change in practice