Since the Covid-19 pandemic a greater emphasis has been placed on staff wellbeing in healthcare, with a range of support services available. Despite this, the 2022 NHS staff survey revealed that 44.8% of staff felt unwell due to work-related stress (NHS, 2023).
Stress can affect the quality of care delivered to people and communities, affecting compassion, professionalism and effectiveness (West et al, 2020). Yet only 30% of health visitors report to have access to good-quality clinical supervision (Institute of Health Visiting, 2023).
“Staff can acknowledge both conscious and unconscious processes in a safe environment”
A group supervision model used in the Maternal and Early Sustained Childhood Home-visiting (MECSH) programme has been designed to support health visitors’ wellbeing and the development of their capacity to reflect on practice, to provide professional support that is effective and safe for both the family and the practitioner (Kemp, 2018).
MECSH is an evidenced-based programme for families needing additional support (targeted or specialist levels of support), delivered by health visitors in the UK. Families receiving MECSH have multiple levels of complex challenges that health visitors are exposed to on a regular basis. This can be overwhelming on both a practical and an emotional level. Staff need to be supported through regular robust supervision to help them process and reflect on their experiences.
Many different models of supervision are used in UK nursing and health visiting teams, such as clinical, managerial, safeguarding and restorative. The partnership model used in MECSH focuses on the restorative/supportive and formative/educative elements of clinical supervision. It uses the ‘Hole in the Ground’ tool to promote both reflection ‘in practice’ (by the practitioner during their work with families), and ‘on practice’ (to give the practitioner and supervisor a shared language for safe reflection through an established supervision structure) (Kemp, 2018).
The families receiving MECSH are often metaphorically in a hole, where they need additional resources and support to get out and move forward. The hole in the ground metaphor is used to enable health visitors to reflect on situations they themselves, or the families they are working with, may find themselves in, and view the situation objectively. This removes subjective blame and any disabling perceived positions of helplessness or hopelessness, enabling empowerment.
The supervisor encourages a solution-focused approach. Building of internal resilience resources is accompanied by the underpinnings of social capital theory, to develop links and resources that may facilitate change. The challenges faced by health visitors benefit from the same approach as those of the families they work with, and thus a parallel process is used in supervision.
The supervisors provide an example for supervisees, who in turn set an example for parents, who then set an example for their children, with the ultimate the aim of keeping families moving forward, out of the hole.
The structure provided by the preplanned, diarised sessions enables the supervision to focus on staff wellbeing, so they can acknowledge both conscious and unconscious processes in a safe environment. The five key areas for promoting emotional wellbeing – connecting with people, being active, continuing to learn, giving to others and taking notice – are incorporated in sessions using mindfulness techniques, active reflection, professional development and ‘walk and talk’ (extending sessions to include a walk with the supervisee).
Practitioners who feel well contained and supported can then better support the families they work with. Routine evaluation shows that 94% of staff receiving this model of supervision rated their experience as either ‘good’ or ‘very good’.
It is critical to prioritise the safety and wellbeing of health visitors at work. Stress levels in health visiting continue to increase, given the estimated shortfall of 5,000 health visitors in England, a 40% decrease in this workforce since 2015 (Institute of Health Visiting, 2023).
While there is an urgent need to increase the number of health visitors being recruited and trained, providing adequate support to those in practice could help retain the existing workforce during these difficult times. Supervision models such as the one discussed here are crucial to building a compassionate and resilient workforce that can contribute to better outcomes for patients, children, families and communities.
Sharin Baldwin is senior health visitor research lead, Institute of Health Visiting, London, UK, and adjunct research fellow, School of Nursing and Midwifery, Western Sydney University, Australia; Karen Dobor is MECSH supervisor consultant, School of Nursing and Midwifery, Western Sydney University.
Disclaimer: Sharin Baldwin completed this work while on secondment from the Institute of Health Visiting (IHV) to Western Sydney University. The IHV retains its independent status and this agreement should not be construed as an endorsement by the IHV of Western Sydney University or its actions, including the MECSH programme.
Institute of Health Visiting (2023) State of Health Visiting, UK Survey Report: A Vital Safety Net Under Pressure. IHV.
Kemp L (2018) Hole in the Ground: a reflective practice supervision tool for partnership-based professional support model. Western Sydney University.
NHS (2023) 2022 NHS Staff Survey: Results. nhsstaffsurveys.com (accessed 24 January 2024).
West M et al (2020) The Courage of Compassion: Supporting Nurses and Midwives to Deliver High-quality Care. The King’s Fund.