To Record or Not to Record: Documentation in Clinical Supervision

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Despite the continued interest of nurses in clinical supervision there remain many unanswered questions and unresolved issues. One such key issue is that of record keeping within clinical supervision. Consequently, this article reviews the limited literature that addresses this issue. It is evident that there are three principle discrete positions regarding recording in supervision and these are summarized as (1) the superviser records minimum data to meet the needs of audit (2) the supervisee makes extensive notes for his/her learning journal, reflective diary and (3) the superviser records headings or key words to be used as an aide-mèmoire. The article then uses three case studies to illustrate particular concerns that the trainee supervisees have raised with regard to recordkeeping that centre around these three positions, and discusses the issues that arise from these concerns. As a result of this discussion, the author reasons that, when entering supervision, either as a new superviser or as a supervisee, it may well be necessary and beneficial to give mind to issues of recording. While it is unlikely that there is one 'perfect way' that will suit every practitioner, the article concludes with some general guidelines which may help in this deliberation.


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