EMPIRICAL STUDIES

doi: 10.1111/j.1471-6712.2007.00548.x

Changes in the effects of process-oriented group supervision as reported by female and male nursing students: a prospective longitudinal study
Barbro Arvidsson RNT, PhD (Senior Lecturer, Professor)1,2, Amir Baigi MSc (Stat.), PhD3 and Ingela Ska rsa ter
RN, PhD (Senior Lecturer)4
1

School of Social and Health Sciences, Halmstad University, Halmstad, Sweden, 2Faculty of Nursing Science, Gjvik University College, Gjvik, Norway, 3Department of Primary Health Care, The Sahlgrenska Academy at Go teborg University, Go teborg, Sweden, and 4Faculty of Health and Caring Sciences, Institute of Nursing, The Sahlgrenska Academy at Go teborg University, Go teborg, Sweden

Scand J Caring Sci; 2008; 22; 437444 Changes in the effects of process-oriented group supervision as reported by female and male nursing students: a prospective longitudinal study The aim of this prospective longitudinal study was to perform a large-scale investigation over a longer period of time, to evaluate changes in the effects of process-oriented group supervision (PGS) as reported by female and male nursing students undergoing a 3-year nursing education. The study included nursing students (n = 183) who were followed during their 3-year study period in relation to their participation in PGS. Methods: A questionnaire consisting of three subscales: supportive (six items), educational (six items) and developmental (six items) as well as three items of a sociodemographic character (age, gender and previous experience of healthcare work) was used. Students t-test was conducted to compare the educational, supportive and developmental subscales between the rst and third year. Results: Females had a signicant increase in the educational subscale (p = 0.018) over the 3-year study period, while no such difference was found for the males

(p = 0.733). The female students also exhibited an increase in the supportive subscale (p = 0.031) over the 3-year period, while there was no difference for the male students (p = 0.426). There was also an increase in the developmental subscale for the female students over the 3-year period (p = 0.047) but no signicant difference for their male counterparts (p = 0.912). For the study group as a whole, an increased positive effect of supervision was observed in the educational subscale (p = 0.020). Conclusions: The ndings have strengthened the argument for the use of PGS in nursing education. To achieve the goal of PGS, which is supportive, educational and developmental in nature, it is important to bear in mind that the supervision needs of women and men can differ. Further research should therefore map out the supervisees experiences and expectations of participating in a single sex group. Keywords: effects, gender, nursing students, processoriented group supervision, longitudinal, questionnaire. Submitted 23 February 2007, Accepted 3 September 2007

Background
The last two decades have seen extensive changes in the education of nurses (1). Nursing has undergone a professionalisation process based on academic competence. Such a process involves a denition of the core competence, which in the case of the nursing profession is nursing care. Nurses are trained not only to be the custodians of this

Correspondence to: Barbro Arvidsson, School of Social and Health Sciences, Halmstad University, PO Box 823, SE 301 18 Halmstad, Sweden. E-mail: barbro.arvidsson@hos.hh.se

knowledge, but also to develop it (2). In Sweden, nursing has become a knowledge-seeking and academic subject in its own right, comprising 3 years of full-time studies leading to a Bachelors degree equalling 120 credits or 180 European Credit Transfer and Accumulation System (3). The demand for quality in knowledge generation includes reection, argumentation, critical analysis and the ability to apply and evaluate knowledge (4). These key elements are of decisive value for preparing nursing students to work with strategies that adapt evidence to t specic patient circumstances in clinical practice (5). Nursing education is one of the most unequal in Sweden in terms of gender distribution, with men making up a mere 14% of new students in 2002, while corresponding 437

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B. Arvidsson et al. nursing students with increased self-condence and makes them more attentive to patients (20). Likewise, there is a connection between the effects of group supervision and the nursing students personal growth and development of a professional identity (21), which indicates that reection is a way to bridge the gap between theory and practice (22). No study was found that focused on differences between women and men. Thus, the aim of this prospective longitudinal study was to perform a large-scale investigation over a longer period of time, to evaluate changes in the effects of PGS as reported by female and male nursing students undergoing a 3-year nursing education.

data for 2006 show that 16% of applicants were male (6, 7). Thus, the increase in the number of men who embark on a nursing education is marginal. Only 9% of nurses in professional practice are male. The indications are that the profession will be dominated by women for the foreseeable future. The only specialisations that attract more men than women are paramedical and emergency care. Immediately after graduation, more men take on administrative posts, leading positions in industry or embark on further studies (7). The nurses main subject, nursing care, is based on normative feminine ideals, which means that femininity and nursing are closely linked (8, 9). However, both male and female nursing students are ill prepared for the strong focus on the subject of nursing care and nd it difcult to integrate this knowledge into everyday clinical practice. Clinical placements are designed to provide practical learning by means of an insight into clinical work and it is important to maximise this knowledge (10). The literature contains little information about what constitutes appropriate support and even less about which methods promote deep learning (11). Supervision is described as the start of a professional learning process. The learning takes place within the student but is linked to professional performance, knowledge, attitudes and skills (12). As nursing students encounter many challenges during their education, process-oriented group supervision (PGS) may be an effective support system for helping them to reect on their duties (13). Reection and experiences form the foundation from which skilled clinical judgements are made (14). In PGS, groups of between four and six supervisees are guided by a supervisor. Together with the participants, the supervisors are responsible for creating a climate characterised by trust as well as for advancing the group process, facilitating dialogue, reection and interpretation, which serve as workable and effective tools in the context of supervision (13). Previous research mainly describes supervision from an empirical perspective with focus on Registered Nurses in the clinical eld (15). Nurses perceive that they receive support and gain increased awareness through reecting over their own behaviour as well as that of their colleagues in relation to the care provided (16, 17). PGS in nursing care based on a theoretical structure increases nurses awareness of the quality of the care they provide. They are better able to interpret the patients needs, despite the fact that these are not always clearly expressed (15, 18). Supervisees reect on ethically difcult caring situations, thereby strengthening their professional identity, integrating nursing theory and practice and leading to the development of ethical competence (19). However, there are few studies that focus on the effects of PGS as reported by nursing students. One study revealed that nursing students experiences of PGS demonstrate that both structure and group climate are important for its success (20). The literature indicates that PGS endows

Methods
Design and setting
This prospective longitudinal study took place at a university in the south of Sweden and included nursing students (n = 183) who were followed during their 3-year study period in relation to their participation in PGS. The study was carried out from 2002 to 2005. Permission for the study was obtained from the Ethics Committee at Lund University, Sweden, (LU 39603), as well as from the Dean of the university involved.

Process-oriented group supervision

All nursing students enrolled in the 3-year nursing programme at a department of nursing participated in PGS during their 3-year nursing education. The PGS was performed as individual supervision in a group, whereby individual students alternately received supervision and attention. The group was regarded as a tool for reection, by which the students took part in each others development and had an opportunity for mutual learning. The groups consisted of 68 students (approximately six females and one to two males) and one supervisor. There were a total of 23 groups and the same number of supervisors. The supervisors came from the university as well as from the care services. All supervisors were women appointed by the management of the university. Supervision was a compulsory component of the nursing education and consisted of six 90-minute sessions during each study year. Thus, a total of 18 sessions took place over the 3-year period at which the students attendance was compulsory. After 3 years students who had participated in 75% or more of the sessions received a certicate stating that they had successfully completed the PGS. The group supervision sessions were conducted within the university. The composition of the group remained the same during the 3 years, apart from the fact that a new supervisor was appointed for the third and nal year. The change of supervisor meant that new questions were raised and new angles of approach were made possible, leading to deeper

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Changes in the effects of process-oriented group supervision reection. The group supervision sessions were carried out using a systematic approach based on clear rules laid down in a contract between the supervisor and the nursing students, which included structural factors such as continuity, condentiality and responsibility. The point of departure was the nursing students experiences of care situations and their educational content. At each session, one of the students was invited to be in focus and to narrate a chosen care situation, after which the group members posed questions about his/her thoughts, actions, feelings and experiences related to the situation. During the rst year, the supervisor, together with the students, devoted a great deal of effort to creating a sense of security and trust within the group. During the second year, the integration of theory and practice became increasingly obvious and was further developed in the third and nal year. The content of the supervision was characterised by increasingly complex care situations based on a holistic perspective on the patient (23).
Table 1 The items in the process-oriented group supervision questionnaire

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The process-oriented group supervision questionnaire

The PGS questionnaire (PGSQ) (24) was developed based on a systematic literature review, student expectations with regard to professional skills and personal growth, and the research teams specic knowledge of the focus of supervision. An 18-item, self-administered questionnaire divided into three subscales was designed (25), with ratings on an ordinal scale from one to seven, where one indicates strongly disagree and seven strongly agree. The items concerned pedagogical and support tools for reection and evaluation with focus on promoting professional skills development and personal growth. The student had to respond to items such as: My own experiences are illuminated at a deeper level (educational subscale); I am allowed to be myself in the group (supportive subscale) and The PGS enhances reective ability (developmental subscale) (Table 1). Validity and reliability tests were performed by means of Factor analysis and Cronbachs alpha. The internal consistency reliability (using Cronbachs alpha co-efcient) was good (Table 2). Furthermore, the questionnaire included three items of a socio-demographic character (age, sex and previous experience of healthcare work).

Supportive I feel safe in the group I am allowed to be myself in the group I have condence in the group There is a warm atmosphere in the group There is a sense of solidarity in the group There is freedom of opinion within the group Educational The group supervision focuses on clinical practice in a satisfactory way The supervisor provides feedback The supervisor provides necessary guidance My own experiences are illuminated at a deeper level The group supervision focuses on the role of the nurse in a satisfactory way The supervisor motivates attendance at the supervision sessions Developmental The group supervision enhances verbal ability The group supervision enhances analytical ability The group supervision enhances social competence The group supervision enhances reective ability The group supervision enhances self-knowledge I now nd it easier to accept criticism

main researcher was aware that any help provided to the student when answering the questionnaire had to be impartial to avoid bias in the responses.

Data analysis
Construct validity measured by means of explorative factor analysis (principal component analysis with varimax rotation) was used to validate the questionnaire. The items were highly correlated to each other with low correlation to other variables. To test the adequacy of the method the KaiserMeyerOlkin measure of sampling adequacy was used (T1: 0.88, T2: 0.92). Test of sphericity was carried out by Bartletts test (T1: p < 0.0001, T2: p < 0.0001). An internal consistency reliability score >0.70 measured by means of Cronbachs alpha coefcient was deemed adequate. Students t-test was conducted to compare the educational, supportive and developmental subscales between the rst and third year. The two-sided test was used and the level of signicance was set at 5%. All data were analysed using SPSS 14.0 (SPSS Inc., Chicago, IL, USA).

Data collection
The main researcher gave each nursing student oral and written information explaining the purpose of the study, the voluntary nature of participation and the condentiality of the data. After the rst and third year of study, thus on two occasions, students who had participated in 75% or more of the sessions were asked to evaluate their experiences of PGS by means of the PGSQ, which they answered in the classroom, a task that required <15 minutes. The

Findings
A total of 183 nursing students participated in the study, of whom 158 (86.3%) were female and 25 (13.7%) male (p < 0.0001). The mean age of the females was 30.9 (SD 8.1; median 30; minimummaximum: 2057) and the mean age of the males 27.1 (SD 5.4; median 25; minimummaximum: 2139), representing a signicant

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Table 2 Validity and reliability tests performed by means of factor analysis and Cronbachs alpha

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T1 Mean SD Factor I Factor II Factor III Cronbachs alpha Mean SD Factor I Factor II

T2 Factor III Cronbachs alpha

34.1 5.7 0.83 0.76 0.75 0.73 0.72 0.55 30.1 7.9 0.82 0.79 0.77 0.75 0.65 0.62 23.4 7.5 0.82 0.78 0.75 0.73 0.65 0.62 0.84 0.87 24.9 8.1 0.85 32.0 7.7 0.84 0.83 0.75 0.75 0.70 0.70

0.89

35.2 6.1 0.86 0.83 0.80 0.77 0.77 0.61

Supportive feel safe in the group allowed to be myself in the group have condence in the group a warm atmosphere in the group a sense of solidarity in the group freedom of opinion

0.93

Educational focus on clinical practice provides feedback provides guidance experiences are illuminated at a deeper level focus on the role of the nurse motivates attendance at the supervision sessions

0.89

0.91 0.85 0.84 0.77 0.75 0.70 0.69 0.90

Developmental enhances verbal ability enhances analytical ability enhances social competence enhances reective ability enhances self-knowledge easier to accept criticism Total

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Factor I: Supportive. Factor II: Educational. Factor III: Developmental.

Changes in the effects of process-oriented group supervision

Table 3 Baseline demographic characteristics of nursing students (n = 183) who participated in process-oriented group supervision

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Male n Age Sex Previous experience of healthcare work 25 25 12 Mean SD 27.1 5.4 Minimummaximum 2139 13.7 6.6 %

Female n 155 158 117 Mean SD 30.9 8.1 Minimummaximum 2057 86.3 63.9 %

difference (p = 0.042). One hundred and seventeen (63.9%) females and 12 (6.6%) males had previous experience of healthcare work (Table 3). The ndings showed that from a gender perspective, there were differences in the effects in all three PGS subscales. The female students assessments of the PGS became signicantly higher over the 3-year period compared with those of their male counterparts. The male and female respondents found the intervention benecial in the educational subscale (p = 0.018 and p = 0.733 respectively), the supportive subscale (p = 0.031 and p = 0.426 respectively), and the developmental subscale (0.047 and p = 0.912 respectively) (Table 4). For the study group as a whole (n = 183), an increased positive effect of supervision was observed in the educational subscale (p = 0.020). As can be seen in Table 5, there was no signicant difference in scores in the supportive or developmental subscales over the 3-year period.

Table 5 Effects on educational, supportive and developmental subscales reported by the nursing students

T1 Subscales Educational Supportive Developmental n 179 182 179 Mean (SD) 30.8 7.9 34.1 5.7 23.4 7.5

T2 n 172 170 171 Mean (SD) 32.0 7.7 35.2 6.1 24.9 8.1 T1T2, p-value 0.020 0.087 0.068

T1 = baseline; after year one; T2 = after year three; T1T2 = year 13 follow-up.

Discussion
Methodological issues
This study was prospective and longitudinal and the outcome is based on a cohort of nursing students that was

Table 4 Effects on educational, supportive and developmental subscales reported by the male (n = 25) and female (n = 158) nursing students

T1 Subscales n Mean (SD)

T2 n Mean (SD) T1T2, p-value

Educational Males 25 Females 154 Supportive Males 25 Females 157 Developmental Males 25 Females 154

27.8 8.5 30.5 7.8 34.0 4.9 34.1 5.9 21.8 6.8 23.6 7.6

23 149 23 147 25 148

28.6 6.7 35.6 7.7 32.7 6.7 35.6 5.9 21.5 8.1 25.4 8.0

0.733 0.018 0.426 0.031 0.912 0.047

T1 = baseline; after year one; T2 = after year three; T1T2 = year 13 follow-up.

sufciently large to allow generalisation of the ndings. No power analysis was made because of the fact that the present study is evaluative in character and based on existing material. The sample available for processing thus consisted of 25 men and 158 women. Although the sample was a convenience sample, the characteristics of the participants are similar to the entire population of nursing students. Future studies in this area may benet from a randomly chosen sample, whose size is determined ahead of time using power analysis. There was a signicant difference in terms of both age and sex among the nursing students. The signicant difference in terms of the age of the nursing students showed that the females median age was 5 years higher than that of the males and that the female students had a wider age range. Longitudinal studies entail a risk of dropout as a result of the duration of the intervention. However, the dropout rate was <9%, i.e. a maximum of 16 students, possibly because of the fact that the students answered the questionnaire in the classroom environment. The self-administered questionnaire was developed based on a systematic literature review, student expectations and the research teams specic knowledge of the focus of supervision and showed satisfactory face and content validity. When studying the effects of an intervention it is important to reect on the attention paid to the informants, as this could have an impact on their evaluation, the so-called Hawthorne effect. Thus, one limitation of this study could be that the nursing students had a positive attitude towards answering the questions, because of the attention they received by participating in the study. They answered the questionnaire by means of positive and negative response alternatives on

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B. Arvidsson et al. supervision more effective than supervision in a one-toone session and that there was an additional benet to be gained from the other members of the group who were also able to offer advice and support (29). One factor that can explain the result in the supportive subscale is that the PGS in this study was conducted in small groups, where the male nursing students were in a minority. Kanter (30) argues that numerical proportions create particular interactional dynamics within a group, thus inuencing how certain types of group members react to other members of the group. Some of the structural factors in this study were unsatisfactory, such as the fact that the group was led by female supervisors appointed by the university, who could have been known to the nursing students in their role as teachers. Supervisees are more likely (31) to disclose personal information when they choose their supervisor or when the supervisor is independent of the setting in which the supervisees are employed. Important factors in the choice of a supervisor (32) seem to be mutual trust, respect for each other and feeling comfortable in each others presence. The ndings show that there was a signicant difference in the female group in the developmental subscale but not in the study group as a whole. High-quality nursing means being able to show feelings such as love and empathy, attributes often associated with female identity building. Efciency and rationality are closely linked to medical and technical knowledge. The basic nursing care of the patient is not valued as highly as specic medico-technical tasks. Men try to distance themselves from ideals that may be perceived as feminine. Tasks of a technical or medical character enjoy higher status compared with nursing-oriented tasks (26). The results can be understood in the light of the focus of supervision, which is patient-centered care. Although male students are of the opinion that more men are needed in patient-centered care, men tend to avoid this type of work. One explanation may be that such care does not have as high a status as, for example, emergency care (9). Instead, men concentrate on technology, emergency care and leadership (33). However, they also shape their work role to be more masculine by emphasising their taskoriented as opposed to people-oriented behaviour. In so doing, male nurses are able to distance themselves from their female colleagues and the feminine work strategy, which stresses a care-oriented rationality (34). Challenging interventions should be viewed as offering a gift that can enhance the supervisees understanding and insight (35). Conversely, change is a difcult process. However, PGS offers an opportunity to reect on the exercise of ones profession and the fact that dialogue facilitates the transformation of theory into practice, eventually beneting the patient and enhancing the care provided (36). An essential element of the supervisory relationship is that the supervisor must believe that the

a seven-point scale. Measurability and manageability in practice were ensured by means of a short and easy to use questionnaire, which was related to the aim of the study. The goal of PGS is that the participants should undergo a learning process in a positive atmosphere. The PGSQ seems to be reliable as a result of the high internal consistency of the reliability scores as well as the ease of answering the instrument due to the small number of items. The lack of a control group is a weakness, as other kinds of interventions could have inuenced the nursing students although, to the best of our knowledge, no other intervention took place during the duration of the study. Nevertheless, even the mere fact of being included in the PGS could have affected the nursing students.

Process-oriented group supervision issues

Process-oriented group supervision is a process conducted over a long period and its character is expected to change as time goes by. The female nursing students participating in the PGS reported a signicant difference in the educational subscale in the course of their 3-year nursing education. The ndings show a signicant difference in the educational subscale in the whole study group. The fact that no signicant difference was observed in the male group may be due to women and men having different ways of communicating, with men favouring more direct communication and preferring to talk with other men (26). It is important that, from the start, the supervisor steers the supervision towards group responsibility and invites the participants to take initiatives and share thoughts and feelings related to the group members stated problem, thus offering them the possibility to deliver the highest quality of patient care. In addition to clinical knowledge the supervisees also require compassion and the ability to listen sensitively, which allows them to gain an understanding of the patients illness in the context of his/her experiences, personality and culture (5). In the supportive subscale, a signicant difference was seen in the female group, although there was no such difference in the study group as a whole. The experience of support differs between men and women (27, 28). Men perceived sufcient social support from people in their network and from their families, while women reported the best support came from people outside the family. Perhaps this is one explanation of the nding that female nursing students consider PGS more supportive than their male counterparts. The supervision sessions were conducted in groups. Several researchers are of the opinion that this is the most effective mode of organising supervision (16, 20). Group supervision is a form of learning within an interactive relationship and appears to be the favoured method in the Nordic countries (15, 20). Supervisees taking part in group sessions felt that the advice and support provided by their supervisor made this form of

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Changes in the effects of process-oriented group supervision supervisees have the potential to grow and develop, otherwise he/she will be unable to empower them.

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Conclusions
The ndings of this study have strengthened the argument for the use of PGS in nursing education. To achieve the goal of PGS, which is supportive, educational and developmental in nature, it is important to bear in mind that womens and mens supervision needs can differ. Further research should map out the supervisees experiences and expectations of participating in a single sex group.

Author contributions
Barbro Arvidsson was responsible for the studys design, collected and analysed the data and wrote the paper, and is also the primary author. Amir Baigi analysed the data and provided advice on the paper. Ingela Skarsater analysed the data, wrote part of the paper and provided advice on the paper.

Funding
This study has been funded by the School of Social and Health Sciences, Halmstad University, Sweden.

References
1 Midgley K. Pre-registration student nurses perception of the hospital-learning environment during clinical placements. Nurse Educ Today 2006; 26: 33845. hle n J, Segesten K. Professionalization-theoretical analysis 2 O of the implications for nursing practice. Scand J Caring Sci 1993; 8: 38. 3 SOSFS 1995:15. Kompetenskrav fo r tja ring som sjuksko nstgo terska och barnmorska (General Guidelines for Required Qualications for Nurses and Midwives). 1995, The Swedish National Board of Health and Welfare, Stockholm. 4 SFS 1992:1434. Ho gskolelagen (The Higher Education Act). 1992, The Educational Institution Code of Statues, Stockholm. 5 DiCenso A, Ciliska D, Guyatt G. Introduction to evidencebased nursing. In Evidence-Based Nursing. A Guide to Clinical Practice (DiCenso A, Ciliska D, Guyatt G eds), 2005, Elsevier Mosby, St. Louis, MO, 319. 6 Swedish Universities. University Colleges Annual Report. 2002, National Agency for Higher Education, Stockholm. 7 Swedish Universities. University Colleges Annual Report. 2006, National Agency for Higher Education, Stockholm. 8 Skeggs B. Formations of Class and Gender. 1997, Sage publications, London. 9 Jorfeldt I. Att utbilda sig till sjuksko terska Ett genusperspektiv pa la rares och studenters beskrivningar av utbildningen (Nursing Education a Gender Perspective on Teachers and Students Descriptions of the Education). 2004, Department of Education, Studies in Educational Sciences, 69, Stockholm.

10 Andrews G, Brodie D, Andrews J, Hillan E, Thomas G, Wong J, Rixon L. Professional roles and communications in clinical placements: a qualitative study of nursing students perceptions and some models for practice. Int J Nurs Stud 2006; 43: 86174. 11 Andrews M, Roberts D. Supporting student nurses learning in and through clinical practice: the role of the clinical guide. Nurse Educ Today 2003; 23: 47481. le G, Carlsen L. Omva rdnadshandledning 12 Hermansen M, Vra (Nursing Supervision). 1994, Studentlitteratur, Lund. 13 Arvidsson B, Fridlund B. Factors inuencing nurse supervisor competence: a critical incident analysis study. J Nurs Manag 2005; 13: 2317. 14 Stockhausen L, Artistry M. Revealing reection-inaction in everyday practice. Nurse Educ Today 2006; 26: 5462. 15 Arvidsson B, Lo fgren H, Fridlund B. Psychiatric nurses conceptions of how a group supervision programme in nursing care inuences their professional competence: a 4-year follow-up study. J Nurs Manag 2001; 9: 161 71. 16 Butterworth T, Carson J, White E, Jeacock J, Clements A, Bishop V. It is Good to Talk. An Evaluation Study in England and Scotland. 1997, University of Manchester, Manchester. 17 Marrow CE, Macauley DM, Crumbie A. Promoting reective practice through structured clinical supervision. J Nurs Manag 1997; 5: 7782. 18 Hyrka s K, Paunonen-Illmonen M. The effects of clinical supervision on the quality of care: examination the results of team supervision. J Adv Nurs 2001; 33: 492502. 19 Berggren I, Barbosa da Silva A, Severinsson E. Core ethical issues of clinical nursing supervision. Nurs Health Sci 2005; 7: 2128. 20 Lindgren B, Brulin C, Holmlund K, Athlin E. Nursing students perception of group supervision during clinical training. J Clin Nurs 2005; 14: 8229. 21 Holm A-C, Lantz I, Severinsson E. Nursing students experiences of the effects of continual process-oriented group supervision. J Nurs Manag 1998; 6: 10513. 22 Severinssson EI. Bridging the gap between theory and practice: a supervision programme for nursing students. J Adv Nurs 1999; 27: 126977. 23 Sarvima ki A, Stenbock-Hult B. Caring: an Introduction to Health Care from a Humanistic Perspective. 1993, Foundation for Nursing Education, Helsinki. 24 Arvidsson B, Ska rsa ter I, Baigi A, Svensson M-L, Fridlund B. The development of a questionnaire for evaluating processoriented group supervision during nursing education. Nurs Educ Prac 2008; 8: 8893. 25 Go ransson A., Dahlgren LO, Lennerstrand G. Changes in conceptions of meaning effects and treatment of amblyopic. A phenomenographic analysis of interview data from parents of amblyopic children. Patient Educ Coun 1998; 34: 21325. 26 Ekstrand P. Tarzan and Jane Hur ma terskor n som sjuksko formar sin identitet (Tarzan and Jane How Male Nurses Shape their Identity). 2005, Uppsala University, Uppsala, Studies in Education. 27 Ska rsa ter I, Dencker K, Bergbom I, Ha ggstrom L, Fridlund B. Womens conceptions of coping with major depression in

2008 The Authors. Journal compilation 2008 Nordic College of Caring Science

444

B. Arvidsson et al.
32 Wilkin P. Clinical supervision and community psychiatric nursing. In Clinical Supervision and Mentorship in Nursing, 2nd edn (Butterworth T, Faugier J, Burnard P eds), 1998, Chapman Hall, London, 189204. 33 Lupton B. Explaining mens entry into female-concentrated occupations: issues of masculinity and social class. Gend Work Org 2006; 13: 10328. 34 Evans J. Men in nursing: issues of gender segregation and hidden advantage. J Adv Nurs 1997; 26: 22631. 35 Cutcliffe J, Epling M. An exploration of the use of John Herons confronting interventions in clinical supervision: case studies from practice. Psychiatr Care 1997; 4: 17480. 36 Clouder l, Sellars J. (2004) Reective practice and clinical supervision: an interprofessional perspective. J Adv Nurs 2004; 46: 2629.

28

29

30 31

daily life: a qualitative, salutogenic approach. Issues Ment Health Nurs 2003; 24: 41939. Ska rsa ter I, Dencker K, Ha ggstrom L, Fridlund B. A salutogenetic perspective on how men cope with major depression in daily life, with the help of professional and lay support. Int J Nurs Stud 2003; 40: 15362. Winstanley J. Developing methods for evaluating clinical supervision. In Fundamental Themes in Clinical Supervision (Cutcliffe J, Butterworth T, Proctor B eds), 2001, Routledge, London, 21024. Kanter R. Men and Women of the Corporation, 2nd edn. 1977, Basic Books, New York, NY. Webb A, Wheeler S. How honest do counsellors dare to be in the supervisory relationship? An exploratory study. Br J Guid Counc 1998; 26: 50924.

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