Development Strategies in Medical Education

Introduction
From the late 1998s and early 1980s, as a result of the re-organization of health services and its acceptance by the Nursing and Midwifery Association, clinical supervision was proposed as a necessary method for the advancement and improvement of employees and maintaining a balance between providing safe and timely patient care and creating learning opportunities for treatment staff [12]. In the field of health, and especially the nursing profession, clinical supervision is one of the basic activities [17]. Clinical supervision is a mechanism for improving the professional knowledge and skills of nurses and performance, which leads to better education and learning of patients to improve their disease conditions and satisfaction, reduce anxiety, hospitalization periods, and treatment costs, and increase capacity and participation in treatment programs [18, 19].
Working as a nurse in special care units, which include ICU (Intensive Care Unit) and CCU (Cardiac Care Unit), is one of the most important and sensitive professions in the healthcare system. These departments require special capabilities and skills from nurses. To improve the quality of cares and minimize possible risks and complications, clinical supervision of nurses in these departments is very important. This study aims to investigate the achievements of clinical supervision on the performance of nurses in special care units of hospitals in Iran.

Methods
This is a qualitative and meta-synthesis study using the seven-step meta-synthesis method of Sandelowski and Barroso [21]. The meta-synthesis team consisted of one physician, three curriculum planning specialists, and one expert in meta-synthesis method. The following steps were used:
1. Setting the research question as “What are the achievements of effective clinical supervision on the performance of nurses in special care units?”
2. Finding relevant studies in Scopus, Emerald, Science Direct, Springer, ProQuest, MagIran, and SID databases from 2019 to 2021;
3. Screening and selecting eligible studies from among 20 yielded studies 
4. Critical evaluation of studies and data extraction using a checklist based on which 12 studies remained (5 had moderate quality, 4 had good quality, and 3 had very good quality)
5. Analysis and synthesis of 12 study findings
6. Quality control using credibility, dependability, confirmability, and transferability criteria
7. Presentation of findings and the conceptual model of the study

Results
Concepts related to clinical supervision were classified into ten basic themes: Pursuing learning opportunities, maintaining interpersonal communication, increasing morale, increasing the quality of patient care, improving patient care standards, increasing self-confidence, increasing clinical insight, reducing stress, improving job competence, and increasing job satisfaction. Based on these identified basic themes, a more general classification was made, and they were classified into three main themes: psychological achievements, organizational achievements, and cognitive achievements.

Conclusion
The purpose of this research was to find the achievements of effective clinical supervision on the performance of nurses in special care units of hospitals in Iran. The results showed that these achievements can be classified into three main themes of organizational achievements, cognitive achievements, and psychological achievements. has
Considering that nurses’ work environments have more pressure on them than other environments, the occupational factors of the work environment have more influence on nurses’ performance than physical factors. With clinical supervision, it is possible to overcome the most basic challenges in healthcare centers, including the health of their active and efficient workforce, especially nurses [28]. Clinical supervision can be used to guide nurses to achieve optimal performance in clinical practice and optimal use of learning opportunities [30]. Clinical supervision not only pays attention to the legal and guiding aspects of supervision but also pays attention to its educational aspects. Psychological factors of the work environment can have a negative effect on the performance of nurses, but clinical supervision can improve the performance and comfort of nurses [31]. Organizational achievements are also among the results of effective clinical supervision, which can increase job satisfaction, expand communication, and improve competence and the quality of patient care.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Shiraz University (Code: IR.JUMS.REC.1399.033).

Funding
This article was extracted from a research proposal, approved by the Faculty of Educational Sciences and Psychology, Shiraz University. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors' contributions
Data curation, supervision: Athar Rasekh Jahromi; Writing: Mehdi Mohamadi, Marzieh Mesgar Poor and Parastoo Nabeei; Methodology: Reza Naseri Jahromi; Data interpretation: Solmaz Khademi; Editing: Sedigheh Shadi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank all participants for their cooperation in this study.


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