Journal of Nursing Management, 2007, 15, 853–861

Are supervisors using theoretical perspectives in their work? A

descriptive survey among Swedish-approved clinical supervisors

1 2
AGNETA BERG MSc, PhD, RNT and MARIANNE KISTHINIOS MSc, RN
1
Assistant Professor, Department of Health Sciences, Kristianstad University, Kristianstad and 2Lecturer, Department
of Health and Society, Malmö University, Malmö, Sweden

Correspondence (2007) Journal of Nursing Management 15, 853–861

Agneta Berg
Department of Health Sciences
Kristianstad University
SE - 291 88 Kristianstad
Sweden
E-mail: agneta.berg@hv.hkr.se
BERG A. & KISTHINIOS M.
Are supervisors using theoretical perspectives in their work? A descriptive
survey among Swedish-approved clinical supervisors
Aim The aim of the study was to explore the theoretical perspectives in use
by approved clinical nursing supervisors in Sweden.
Background For the time being, we know little of the theoretical perspectives in
use on a daily basis by the clinical nursing supervisors in Sweden.
Methods A questionnaire (n ¼ 49) and follow-up telephone interviews (n ¼ 14)
were used. Data analysis was made by descriptive statistics and qualitative
content analysis.
Results The result from the questionnaire showed that the supervisors often used
and combined different theoretical perspectives with origins in nursing, education
and psychology. Surprisingly, one-fourth of the respondents did not state any
nursing theoretical perspective in use during clinical nursing supervision. The result
from the interviews revealed that the theory of Katie Eriksson (1987) was the
most commonly used nursing perspective.
Conclusion As the overall aim for clinical nursing supervision is to improve nursing
for the patient/family, the supervisor’s competence in nursing is essential. Given
this fact, and that only three-quarters of the approved clinical nursing supervisors
stated a use of theoretical nursing perspective when supervising, there is obviously a
need for further investigations in this area. In addition, there is also a need for
approved Swedish clinical nursing supervisors, to further become aware of the
theoretical perspective in use that supports their clinical nursing supervision. Clin-
ical nursing supervision is a multifaceted activity that needs to be supported by
different nursing theoretical perspectives including physical, emotional, intellectual,
spiritual as well as socio-cultural aspects.
Keywords: clinical nursing supervision, nurse, theoretical perspective

Accepted for publication: 2 December 2006

perspectives in use is sparse. According to Severinsson

Introduction
Despite an increasing amount of research focusing on
the significance of clinical nursing supervision (CNS) in
Sweden, the knowledge of theories and theoretical
DOI: 10.1111/j.1365-2934.2006.00752.x
ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd
(2001), it is of great importance to scrutinize the
supervisorsÕ competence as well as the values of theor-
etically-based supervision, to reach the goals of the
supervision process. A lack of competence can be
853
A. Berg and M. Kisthinios
devastating, as supervisors influence a large number of
supervisees; they are morally responsible for the
superviseesÕ development and achievement of nursing
competence, and supervisors also pass on their know-
ledge and values concerning caring to the supervisees
(Severinsson 2001). In order to secure the quality of
CNS, the Swedish National Association of Clinical
Nursing Supervision (RfYHO), in cooperation with
the Swedish Association of Nurses (SSF) and The
Swedish Association of Health Professionals, prepared
and established competence criteria and guiding prin-
ciples of approval for clinical nursing supervisors in
November 2000. The purpose of creating guiding
principles of approval was to secure that nurses work-
ing as clinical supervisors have the competence in
providing supervision that is in accordance with the
nursing ethical codes and knowledge foundations
(SSF & RfYHO 2005).
Research in Sweden on the effects and significance of
CNS has been performed in different specialties such
as dementia, somatic, palliative and psychiatric care
(Hallberg et al. 1993, Berg et al. 1994, Pålsson et al.
1994, Edberg et al. 1996, Severinsson & Hallberg
1996, Berg & Hallberg 1999, 2000, Berg & Welander-
Hansson 2000, Berggren & Severinsson 2000,
Arvidsson et al. 2001). The results showed that CNS
decreased tedium and burnout, increased creativity and
provided relief, confirmation and professional auton-
omy, development, growth, identity and solidarity
among nurses. CNS also led to job satisfaction,
knowledge gain and competence, security in nursing
situations, personal development, self-assurance and
closer relationships between nurses. Moreover, CNS
improved the nursesÕ sensibility towards their patients
and strengthened the foundation for nursing care.
Furthermore, CNS offered an integrated nursing care
perspective, improved the quality of care and the
cooperation between nurses and patients. CNS also
improved the ability to confirm the patient as a unique
human being. Finally, CNS also increased the nursesÕ
ability to support and be in a relationship with the
patients as well as take responsibility. In the above
studies, the intervention with CNS has been performed
by nurse researchers with extensive theoretical nursing
education and long experience as nurses and super-
visors. All the supervisors used nursing theories,
sometimes in combination with other theoretical
perspectives e.g. psychodynamic, salutogenic, when
supervising.
Both internationally and nationally, the empir-
ical research focusing on finding and defining the
characteristics of a good and effective supervisor is
854 ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd, Journal of Nursing Management, 15, 853–861
growing (e.g. Severinsson & Hallberg 1996, Sloan
1996, 1999, Wilson 1999) while the theoretical per-
spective in use is still a less examined factor. Bégat
et al. (2003, p. 11) found, by means of a questionnaire
with fixed questions answered by 86 Australian nurse
supervisors, that Ôreflection theoryÕ was the most
commonly used theory. The second choice of theory
was the human development theory and psychody-
namic theory was their third choice followed by focus
on the nursing process. The least used theory was
pedagogy (Bégat et al. 2003, p. 11). In addition, in a
British study, Veeramah (2002) revealed that out of
100 nurse supervisors/supervisees (community mental
health nurses), answering a questionnaire with fixed
questions, 98% reported psychotherapy as a theoret-
ical perspective in use, 20% theory based on the
humanistic school, 19% on the behavioural school,
7% on the psychoanalytical school and finally 52%
stated an eclectic approach involving a combination of
more than one school. It could be argued that as the
overall aim for CNS is to develop the profession and
improve nursing for the patient/family, a reasonable
starting point might be that CNS is underpinned by a
nursing theoretical perspective (cf. Chambers & Long
1995).
For the time being, we know little of the theoretical
perspectives in use on a daily basis by the clinical
nursing supervisors in Sweden. Earlier research in
Sweden, performed before the establishment of com-
petence criteria for clinical nursing supervisors,
showed that of 11 clinical nurse supervisors the most
commonly used theoretical perspective was psychody-
namics followed by the existential, socio-psychologi-
cal, nursing and medical perspectives (Petersson 1995).
Enarsson and Sandman (1998) showed that clinical
nursing supervisors (n ¼ 4), randomly selected from
the 12 universities in Sweden that pursued pro-
grammes in CNS had an unclear theoretical perspec-
tive and that they rather related to how their
supervisory work was performed in practice. The
charting of these universities showed that one pro-
gramme had a psychosocial theoretical perspective
with psychiatric context and sociological features.
Three programmes had a psychodynamic theoretical
perspective, while two programmes had influences
from ÔNorwegian supervisionÕ. In addition, one pro-
gramme emphasized education and one programme
had a clear nursing theoretical perspective. Four pro-
grammes could not be categorized and were named
eclectic. Given this, it seems worthwhile to investigate
the theoretical perspective in use by approved Swedish
clinical nursing supervisors.
 Theoretical perspectives in clinical practice

represented 11 of 21 county councils in Sweden, with a

Aim
preponderance in Västerbotten, Skåne, Halland and
The aim of the study was to investigate the theoretical Västra Götaland. Forty respondents gave their written
perspectives in use by approved Swedish clinical nursing consent to be contacted for a telephone interview and
supervisors. out of those that stated a nursing theoretical perspective
in use (n ¼ 36), 14 were randomly selected (one man,
13 women). The study was approved by the Council of
Method Ethics at the University of Kristianstad. Dnr 2004-06
(2004-03-01).
Subjects
All approved clinical nursing supervisors (n ¼ 79)
Questionnaire
registered in May 2004 by SSF (Swedish Association of
Nurses) received a letter of introduction and a ques- First, a questionnaire with both fixed and open
tionnaire. They were also asked about their interest to responses was especially developed for this study
participate in a follow-up telephone interview. The (n ¼ 19). The questions covered the following areas:
respondents that gave their consent were asked to state demographic characteristics (age, gender), qualifications
their name, telephone number or e-mail address. Forty- (i.e. year of graduation, credit points in nursing), work
nine questionnaires (Table 1) were returned resulting in experience and characteristics (i.e. years in nursing,
a response rate of 62%. All respondents were Regis- working position), supervision characteristics (i.e. do
tered Nurses educated from 1963 up until 1994 and you supervise individually and/or in group?, what kind
of professionals categories do you supervise?, how many
Table 1 individuals does your group consist of?, what is your
Descriptions of the respondents (n ¼ 49) main focus during supervision sessions?) and theoretical
n
perspective in use while supervising (i.e. what theoretical
perspectives do you use when supervising?). Secondly,
Age 10 nurses and/or nurse teachers familiar with CNS pilot-
Median (range) 50 (33–65) 46
Sex
tested and assessed the appropriateness of the ques-
Male/female 3/45 48 tionnaire for the study, which resulted in minor editorial
Credits points in nursing* changes in the demographic part of the questionnaire.
21–40 8 47
41–60 12
61–80 11
Interviews
>80 13
don't know 1 Fourteen respondents where contacted for a follow-up
Post graduate qualifications 
Psychiatric care 22 44 telephone interview (Kvale 1996). Before the interview
Medical/surgical care 10 an additional letter consisting of information about the
Intensive/anaesthetic care 8 aim of the study and the interview questions was sent to
Midwifery 6
District nursing 3
the respondents. The interviews focused on two open
Paediatrics 3 questions: Ôcould you please tell me what/which nursing
Other qualificationsà theoretical perspective do you use while supervisingÕ
Clinical supervision 15 38
and Ôhow do you put it into practiceÕ. Additional ques-
Nursing education 14
Education 8 tions to clarify, further develop or deepen the answers
Psychotherapy/Psychology 7 were used (i.e. could you please concretize and exem-
Management 5 plify? or could you explain that a little bit more?). The
Ethics 4
Work experience (years) interviews were conducted during the summer of 2004
Registered nurse and lasted between 20 and 50 minutes. The transcrip-
Median (range) 19 (3–30) 45 tion was made by the second author (MK) and checked
Supervisor in nursing
Median (range) 7 (1–29) 47
by the first author (AB) in order to ensure quality.

*Two respondents had 80 credit points in education/nursing educa-

tion. Analysis
 Eight of the respondents stated more than one postgraduate qual-
ification. The fixed questions in the questionnaires were analysed
àFifteen of the respondents stated more than one other qualification. by means of descriptive statistics using the software

ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd, Journal of Nursing Management, 15, 853–861 855
A. Berg and M. Kisthinios
Statistical Package for Social Sciences (SPSS/PC, version
12.0). The transcribed text (approximately 60 pages in
single-space) from the telephone interviews was ana-
lysed by means of qualitative content analysis (Berg
2001, Graneheim & Lundman 2004) focusing on the
manifest content, that is, visible and obvious elements,
referred to as surface structures present in the message
(compared with the deep structures analysed in latent
analysis, focusing on the deep structural meaning con-
veyed in the message).
The analysis was made inductively in different steps.
The first step in the analysis was to read the units of
analysis, in this case the transcribed interviews
repeatedly, to obtain a overall understanding of the data
and gain ideas for further analysis. In the second step,
the text concerning the respondentsÕ different theoret-
ical perspective in use was extracted and brought
together into one text, which constituted the meaning
units, which refer to words or sentences containing as-
pects related to each other through their content and
context (e.g. tending, playing or learning). In the third
step, the meaning units were condensed, that is a pro-
cess of shortening while still preserving the core. In the
fourth step, the condensed meaning units were
abstracted which in this case emphasized descriptions
and interpretations on a higher logical level as creating
codes. Each condensed meaning unit was therefore
labelled with a code (e.g. Katie Eriksson’s theory). The
whole context was considered when condensing and
labelling meaning units with codes. This process was
carried out independently by the two authors to ensure
the credibility of the findings. In the fifth step the var-
ious codes were sorted into categories (e.g. nursing
theory focusing on caritas), which constituted the
manifest content. There was an intent to present the
material of the interviews as close to the text as possible
without interpreting. Finally in the sixth step the
interviews were read through to make sure that the
categories covered all aspects of the interviews. One of
the interviews could only partially be used due to the
quality of the tape recording.
Findings
Questionnaires (n ¼ 49)
All respondents except two were working as super-
visors, but only five worked full time as supervisors.
The rest worked as supervisors in combination with
working as Registered Nurses (n ¼ 16), university lec-
turers (n ¼ 12) and managers (n ¼ 10). Eleven of
the respondents stated that they had more than one
856 ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd, Journal of Nursing Management, 15, 853–861
working position such as consultant, self employed,
project manager, and coordinator of science, doctoral
student, senior citizen and principal. All kinds of work
areas were represented with a majority in psychiatric
care (n ¼ 14) and nursing education (n ¼ 9). Most of
the respondents worked in the public sector (n ¼ 39),
two were retired and the rest worked in the private
sector (n ¼ 7).
Group supervision (n ¼ 45) was the most common
and only two stated that they did not supervise in
groups. Most of the respondents supervised both groups
and individually. The group size varied from 2 to 14
supervisees at times. Most common (n ¼ 39) was that
the supervisee group was homogenous and consisted of
Registered Nurses, licensed nurses, nurse students or
other professional categories, i.e. nursing teachers,
personal assistants and managers. Two respondents
stated that they supervised teams in palliative care.
The main focus in the supervision was the nurse–
patient/family relationship (n ¼ 38) followed by the
planning of nursing care (n ¼ 22) and the team
co-operation (n ¼ 18). Four of the respondents stated
that the focus varied and depended on the situation at
hand. A plethora of theoretical perspectives were stated
to be in use during the supervision session. Thirty-six
out of forty-nine respondents stated that they some-
times used a nursing theoretical perspective in combi-
nation with other theoretical perspective such as
psychology, education and sociology (Table 2).
Follow-up interviews (n ¼ 14)
Some of the respondents gave an insecure impression
when verbalizing their theoretical perspectives in use
Table 2
Theoretical perspective in use in CNS (n ¼ 49)
Theoretical perspectives n
Education 1
Education + psychology + sociology 1
Nursing 13
Nursing + psychology 8
Nursing + education 2
Nursing + ethics 1
Nursing + psychology + education 4
Nursing + psychology + sociology 3
Nursing + education + ethics 1
Nursing + psychology + education + sociology 2
Nursing + education + sociology + ethics 1
Nursing + education + sociology + medicine 1
Psychology 2
Psychology + education 4
Psychology + sociology 1
No theory stated 4

when supervising. Most of the respondents consistently
referred to the theorist rather than to the theory. The
most frequently nursing theorist referred to was Katie
Eriksson (Table 3). Each interviewee in the text below
has a specific number ranging from 1 to 14.
Nursing theory focusing on caritas
Katie Eriksson’s nursing theory
All except one of the respondents stated that they used
the theory of Katie Eriksson when supervising. The
respondents described that their theoretical and beha-
vioural approach during supervision was to tend, play
and learn in faith, hope and love. The respondents
assumed that a Ôhuman beingÕ is unity of body, mind
and spirit with responsibility for its actions and with
free will.
…when working with Katie Eriksson’s nursing
theory, it is self-evident to me that a human being
is a being where the body is of great importance
in, for example, the dying processes. Where the
body is very much present, but where the mind
and spirit is a necessity for experiencing some kind
of unity. (Interviewee 13)
The human being is responsible and has a free
will. (Interviewee 5)
ÔSufferingÕ was said to be a phenomenon that both the
supervisor and the supervisees could express during
supervision and thus in a way become seen and
affirmed. The respondents said that a non-affirmation
could lead to an even greater suffering. The theory
was said to be helpful when handling the suffering of
supervisees.
…when I am confronted with the drama of suf-
fering that Katie Eriksson talks of, I am strong
Table 3
Nursing theories used by approved clinical nursing supervisors
Nursing theories focusing on Theorists
Caritas Eriksson
Culture related Leininger
Interaction Orlando
Peplau
Paterson and Zderad
Watson
Needs Henderson
Orem
Rodgers
Other Benner
ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd, Journal of Nursing Management, 15, 853–861
Theoretical perspectives in clinical practice
enough to remain present and actually take in the
other person’s sufferingÕ. (Interviewee 5)
Through ÔtendingÕ the respondents described that the
supervisees were offered the possibility to express feel-
ings connected to the situations presented. The tending
was also said to be expressed in the non-demanding,
respectful encounter.
One can say that the encounter is the first part, the
tending level/the non-demanding encounter.
Where the supervisee can describe and tell her
experience. Openness and respect are important
concepts in tending theory and so to speak the
unconditional affirmation of the experience and
the story toldÕ. (Interviewee 3)
ÔPlayingÕ was expressed by various creative methods
in use during supervision, e.g. imagination, painting and
humour. Playing was understood as the supervisorsÕ
way of creating a safe atmosphere for the supervisees.
… and then, depending on the situation, we use
playing and I really play… For example, I use
painting, listening to tapes… it can be relaxa-
tion… one can choose post cards, and sometimes
we choose someone as the observer… a reflective
team during playÕ. (Interviewee 8)
ÔLearningÕ was said to be an outcome of the tending
and playing, where new knowledge and experiences
were generated.
It is a form of tending and it is done playfully, they
should feel safe and let’s see…and be able to
expose themselves. That one does it in a playful
way. And the conclusion of the playing becomes
the learningÕ. (Interviewee 1)
ÔFaithÕ was expressed in supervision through the
supervisorsÕ underlying Christian values and through
Interviewee number
1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total
x x x x x x x x x x x x x 13
x 1
x 1
x x x 3
x 1
x x x 3
x 1
x 1
x 1
x x 2
857
A. Berg and M. Kisthinios
believing in the superviseesÕ good intentions and their
ability to provide good care.
… I have underlying Christian values… a god that
I trust in… he is with me in my nursing conver-
sations… (Interviewee 6)
ÔHopeÕ for the future was communicated by the
supervisors through the ability to provide the supervisees
with a clear goal for nursing. Ô…to show them hope…
and the future… faith that they can reach the goal…Õ
(Interviewee 11). ÔLoveÕ was to be understood as a caring
way of treating the supervisees, in addition to being a
role model through performing loving actions. Love was
said to lead to safety and trust within the group.
… I try to have a good relationship with those I
supervise… but one is not supposed to rub them
up the right way all the time… love must be the
underlying thing… I am very meticulous in wri-
ting things down after having supervised so that I
remember and so that I can look back… and I
think that is perceived as having really listened.
And it is an act of love… and they are so sur-
prisedÕ. (Interviewee 11)
Nursing theory focusing on culture-related nursing
The cultural aspect in the encounter between the nurse
and patient was emphasized by one respondent using
Madeleine Leininger’s theory. When the supervisees
perceived the patient as troublesome, the supervisor tried
to make it visible that the patient could seem aggressive or
arrogant because of many earlier adversarial encounters.
…when they talk about immigrants that they find
troubling… demanding… or aggressive…I try to
make them see that they [the immigrants] have so
many other issues in their baggage… that they can
overreact to a no…Õ. (Interviewee 4)
Nursing theories focusing on interaction
Three of the respondents used the theory from Hilde-
gard Peplau. The patientsÕ hospitalization was described
in different phases. Depending on actual phase and the
personality of the nurse, the demands and treatments
became different. The respondents also highlighted that
nurses always are role models and play different roles in
the perceived world of the patient.
…Peplau divides the hospitalization in 4 pha-
ses…the phase of orientation… you orientate
yourself in the physical buildings, the environment
858 ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd, Journal of Nursing Management, 15, 853–861
and the personnel… the phase of identification is
when you start pinpointing the problems and
concretizing them. The phase of exploitation
concerns how to approach the problems and the
phase of resolution relates to how to move for-
ward beyond the ward…. (Interviewee 14)
a very structured person… is it a person who
easily becomes anxious? Is it a person who is not
very emotional but… has control over feelings…
and can handle this…. (Interviewee 10)
Three of the respondents highlighted the value of Jean
Watson’s theory when it came to focusing on a human
being’s possibilities rather than limitations. They
believed that the supervisor should encourage the
supervisee to think about what they had seen, heard and
felt in relation to the possibilities of the patient. A pri-
mary task for nurses was to confirm the patient’s being
as a unity of body, soul and spirit.
Above all, it is the creative thought that is
appealing… when it comes to people’s possibilit-
ies…rather than their limitations. I am more often
focused on the possibilities than on the limita-
tions. (Interviewee 13)
By using Ida Orlando’s theory, one of the respondents
focused on the importance of the superviseesÕ respon-
sibility and professional role in the nurse–patient
encounter.
…Orlando points to the encounter. We, the
caregivers, are responsible for a good encounter…
we cannot put these demands on our patients.
(Interviewee 1)
Josephine G. Paterson and Loretta Zderad’s theory
was used by one respondent who felt that nursing,
according to Paterson and Zderad, focused on the
nurse–patient encounter and that the encounter requires
closeness, authenticity, immediacy and existential
awareness.
…Nursing demands closeness, authenticity,
immediacy… the nurse has an existential aware-
ness both of herself and the other… who am I in
this encounter? And this is a process called Ôthe
betweenÕ. (Interviewee 6)
Nursing theories focusing on needs
Virginia Henderson’s theory proved useful for one of
the respondents since it focuses on human needs.

….Henderson is a very useful theorist that I can
use for example when we talk about needs and
stuff. (Interviewee 5)
Another respondent used Dorothea Orem’s theory on
Self-Care Deficit and Nursing System when supervising,
in order to make the supervisees see the patient’s
potential neglect in self-care and how it could be com-
pensated.
If there is a deficit in the patient’s self-care we
discuss how it can be compensated. (Interviewee
10)
Philosophy and nursing theory was said to be inter-
twined for another of the respondents. The way patients
and relatives viewed and understood life could be
highlighted in supervision. Thereafter the interaction
was clarified between patient, family and nurse, on the
basis of Martha Rodger’s nursing theory.
…the life world perspective of Dahlberg and
Giorgi, that is, how hard it can be to meet some-
one… when you don’t understand the situation,
how the parentsÕ situation is. I incorporate Gad-
amer who stands for the preunderstanding…in
some way it becomes an interaction between
patient, family and nurse. (Interviewee 8)
Other
Two respondents stated that the supervising situation
could be understood on the basis of Patricia Benner’s
theory of development from novice to expert. The
situation was said to be evaluated on the basis of where
the supervisee is in her professional development and in
that way increase the understanding of the situation.
I assess where the supervisee is in her professional
development. When it comes to students they are
novices. A nurse in psychiatry who has worked for
15 years is an expert and I have to take that into
account when understanding the situation.
(Interviewee 2)
Discussion
Methodological considerations
There are some limitations that need to be considered
when interpreting the result from this study. The
dropout rate was 38% the reasons for that could be
related to the lack of reminders or that the addresses
were not updated. Other reasons for not returning the
ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd, Journal of Nursing Management, 15, 853–861
Theoretical perspectives in clinical practice
questionnaire could be that they were not working as a
supervisor at the time or perhaps that sensitive ques-
tions were asked. It could also be argued that not
answering the questionnaire was a sign of difficulty in
expressing one’s theoretical perspective in use.
Although the respondents came from different parts of
the country, generalization must be made with caution
considering the response rate. The result from the
questionnaires and telephone interviews did not point in
the same direction as all the interviewed persons used a
nursing theoretical perspective when supervising. Thus,
there is a lack of deeper knowledge about theories in use
by clinical nurse supervisors that did not state any
nursing theories when supervising. Some issues of
trustworthiness must be reflected on. One methodolo-
gical weakness might be the possible lack of depth in the
interviews. The interviews were conducted by telephone
and over a limited period of time, which can influence
credibility (as sufficient time collecting data in order to
have an in-depth understanding was limited). The tele-
phone interviews could be an obstacle in building trust
with respondents, even though in this case most
respondents seemed eager to share their knowledge and
the interviews were substantially rich. The risk that the
analysis of the text would be based only on the
researchersÕ arbitrariness was dealt with by application
of a consistent method. To further enhance trustwor-
thiness quotations from the interviews are shown in the
result sections. The analysis was performed by the sec-
ond author but constantly checked and discussed by the
first author. Transferability refers essentially to the
generalizability of the findings and can only be
obtained through a rich and thorough description of
the research setting, which is believed to be the case in
this study. Only the thorough description can then
provide the concerned in making a transfer in order to
reach a conclusion about whether transfer can be made
or not.
A majority of the supervisors in this study used a
combination of theoretical perspectives such as nursing,
psychology and education. The complexity of CNS
probably requires theoretical knowledge from all these
areas as CNS is a learning process and also includes a
dimension of personal development/growth. This rea-
soning does not support the use of one single theory for
CNS. Still, according to Hyrkäs et al. (1999), there is an
ongoing debate in the literature if CNS should be gui-
ded by a specific theory or not. So far the need for a
specific theory has been strongly criticized as several
scientists have agreed that it is not possible to present
one single theory of CNS. On the other hand, several
859
A. Berg and M. Kisthinios
other researchers have, according to Hyrkäs et al.
(1999), suggested that a theory for CNS is necessary, as
they claim that CNS without a theoretical perspective in
use has no prospects or goal. They also emphasize that
the supervisorsÕ work is based on some kind of frame-
work or theory-in-use; the question is whether the
supervisors are conscious of it or not (Hyrkäs et al.
1999). As all theories are based on different assump-
tions, it can be erroneous to, for example, offer super-
vision based on a psychological theoretical foundation
only, when the supervisees needs a nursing theoretical
understanding of their work to support professional
development. Therefore, it is of utmost importance for
the supervisors to have an understanding of the differ-
ent theoretical perspective in use and their meaning for
the supervision given. In extension it is also a necessity
in order to evaluate CNS.
One-fourth of the clinical nursing supervisors in this
study did not state any nursing theoretical perspective
in use when supervising. This finding is supported by
Arvidsson and Fridlund (2005) who used critical inci-
dents to identify factors that influenced the competence
of Swedish nurse supervisors. They found that only a
few (11 of 141) described how the clinical nursing
supervisors focused on the meaning of nursing care
and the values that govern it. They came to the con-
clusion that clinical nurse supervisors need to include
more nursing theories and focus on the nursing process
during CNS in order to improve the autonomy and the
clarity of the professional clinical nurse supervisory
function. In turn, this raises the question whether there
is a lack of theoretical nursing knowledge in the
offered Swedish programs in CNS? Enarsson and
Sandman (1998) argued that this is the case. All the 12
universities in Sweden, that according to Enarsson and
Sandman (1998) pursued programmes in CNS, started
during the 1990s. The charting of these showed that
only one programme had a clear nursing theoretical
perspective. It could also be argued that the lack of
nursing theory in CNS may be a consequence of low
nursing theoretical demands in the Swedish compet-
ence criteria and guiding principles of approval for
clinical nursing supervisors as the guiding principals
also governs the outlining of CNS programmes in
Sweden.
If the emergence of CNS is a major component in
nursing and according to Bishop (1998) a development
that offers the profession an opportunity to maximize
its competence and potential, and is in the best interest
of patients/families (cf. Chambers & Long 1995) a lack
of nursing theoretical competence might be devastating,
as supervisors influence a large number of supervisees/
860 ª 2007 The Authors. Journal compilation ª 2007 Blackwell Publishing Ltd, Journal of Nursing Management, 15, 853–861
patients. Finally, Severinsson (2001) claimed that a lack
of knowledge in nursing theory will also create diffi-
culties in integrating theory with practice.
The results of the interviews showed that Katie
Eriksson was the theorist most clinical nursing super-
visors referred to. The theory has some main concepts,
i.e. suffering, tending, playing, learning, faith, hope and
love (Eriksson 1987) all frequently used by the inter-
viewees in the present study. Severinsson (Severinsson
& Lindström 1993, Severinsson 1995, Severinsson &
Hallberg 1996) developed a supervision model based on
Eriksson’s theory of caritative caring. This model is also
consequently used by the university that at the time
being has educated most clinical nurse supervisors in
Sweden. According to Severinsson (1995), the model
has its origins in the concept of love and the idea of
mercy and charity as basic motifs for caring. The con-
cept of love is connected to faith and hope, where hope
involves searching for solutions and gives a feeling of
affirmation and the ability to find meaning. This way of
understanding the situations presented might be a
valuable tool when supervising. However, the result
also showed that the supervisors also used other nursing
theories, especially in combination with theories
focusing on interaction. Perhaps this is due to the fact
that Eriksson does not explicitly emphasize the inter-
action and the nurse–patient relationships which often
are highlighted in the literature as the core issue of
nursing. Other nursing theories used by the interviewed
in the present study have their origins in culture-related
nursing and human needs, most likely mirroring the
variety of theoretical knowledge needed in CNS. Rea-
sonably, a theoretical nursing perspective in CNS
including physical, emotional, intellectual, spiritual as
well as socio-cultural aspects might give the supervisors
a well-functioning support in the supervising situation.
Conclusion
As the overall aim for CNS is to improve nursing for the
patient/family, the supervisor’s competence in nursing is
essential. Given this fact, and that only three-quarters of
the approved clinical nursing supervisors stated a use of
theoretical nursing perspective when supervising, there
is obviously a need for further investigations in this area
and a need for approved clinical nursing supervisors in
Sweden to further become aware of the theoretical
perspective in use that supports their CNS. CNS is a
multifaceted activity that most likely needs to be sup-
ported by different nursing theoretical perspectives
including physical, emotional, intellectual, spiritual as
well as socio-cultural aspects.
 Theoretical perspectives in clinical practice

Acknowledgements controlled study in dementia care. Clinical Nursing Research 5

(2), 127–149.
We would like to thank Kristina Kisthinios for assistance with Enarsson P. & Sandman P.-O. (1998) Handledningsstrategier i
language. We would also like to thank all the participants who omvårdnad- En kartläggande studie av handledningsmodeller
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(in Swedish).
Eriksson K. (1987) Vårdandets idé. Almqvist & Wiksells, Stock-
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