Abstract
Objectives
This study aimed to explore and clarify the concept of reflective supervision as a professional self-care strategy to create a positive Intensive Care Unit (ICU) practice environment.
Methods
Walker and Avant’s eight-step concept analysis approach was utilized to identify and define the attributes, antecedents, and consequences of reflective supervision in the ICU. An extensive literature search was conducted across various databases, including Google Scholar, CINAHL, PubMed. Articles published from 2005 to 2025 were identified. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement to indicate the included articles and extract related data based on relevance.
Results
Forty articles were included in the analysis. The identified attributes included the supervisor-supervisee relationship, effective communication, teamwork, collaborations, reflection, competencies, feedback, continuous support, and autonomous choice. The identified antecedents included participation, supportive supervision, flexibility, open-door policy, training, and motivation. Consequences impacting the success of reflective supervision were identified as promotion of resiliency, autonomy, work-life balance, self-awareness, increased self-esteem, professional development, critical thinking, increased job satisfaction, and enhanced commitment.
Conclusions
Reflective supervision is a complex professional self-care strategy that enhances ICU practice, by promoting nurses’ well-being, self-awareness, therapeutic skills, and professional development.
Keywords: Concept analysis, Intensive Care Unit, Nursing, Positive environment, Reflective supervision
What is known?
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The concept of reflective supervision remains ambiguous and complex to understand when applied as a professional self-care practice in Intensive Care Unit (ICU).
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There are inconsistencies in how it should be practiced, leading to misinterpretations in the intensive care practice environment.
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The other ambiguities arise from the interchangeability of the reflective supervision concept with other concepts, such as clinical supervision, reflective practice, and reflective teaching, in an ICU practice environment.
What is new?
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The implementation of reflective supervision as a professional self-care strategy to create a positive ICU practice environment promotes resiliency, autonomy, work-life balance, self-awareness, increased self-esteem, professional development, critical thinking, increased job satisfaction, and enhanced commitment.
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Reflective supervision is a relationship-focused, supportive, and collaborative process that enables reflection in a non-judgmental and supportive environment.
1. Introduction
The concept of reflective supervision is highly valued in social work, psychiatry, and psychology, and its popularity is increasing in Intensive Care Unit (ICU) nursing department. Despite its popularity, reflective supervision is still ambiguous, complex to understand, and challenging to implement as a professional self-care practice in the ICU setting. There are inconsistencies in how it should be practiced, leading to confusion and misinterpretation [1,2]. There are disparities among critical care nurses (CCNs) in their understanding and implementation of reflective supervision in ICU practice environments [2]. Reflective supervision, a professional self-care strategy, aligns with the Strategic Plan 2024–2025, which focuses on facilitating positive work environments by promoting health, well-being, and professional development through learning [3,4]. Healthy, positive work environments are crucial in maximizing the health and well-being of CCNs, enabling them to achieve optimal organizational performance [5].
ICUs are known to be complex, dynamic, highly stressful, and demanding work environments characterized by numerous work-related stressors, including end-of-life issues, ethical dilemmas, caring for critically ill patients, and the need for technical competencies [6]. Stress, burnout, and emotional fatigue contribute to increased attrition rates among CCNs, who often change workplaces or retire early [[7], [8], [9]]. Furthermore, stressors can have a negative impact on the mental health and well-being of CCNs [10,11]. Professional self-care aims to prevent work-related stress by mitigating the effects of burnout and other workplace hazards [12]. Participation in reflective supervision has been shown to reduce burnout, emotional fatigue, and the attrition rate in the ICU practice environment [13,14]. CCNs are required to purposefully engage in practices that reduce stress by promoting an effective professional self [3]. Reflective supervision has a positive impact on the workforce by strengthening, supporting, and maintaining an effective healthcare professional workforce in an ICU environment [15].
Defining the theoretical concept will clarify the meaning of reflective supervision and eliminate inconsistencies that lead to misinterpretations of how reflective supervision should be implemented in ICUs. This study focused on creating a positive practice environment in the ICU through a reflective supervisory process. Furthermore, reflective supervision was analyzed as a professional self-care strategy to make a positive ICU practice environment within oneself, enhancing self-awareness, resilience, and professional development among CCNs. The quality of supervisory relationships is crucial in promoting environmental safety by fostering trust and collaboration. The supervisory relationship fosters respect, confidentiality, self-reflection, and feedback as key components of adequate reflective supervision [[16], [17], [18]]. CCNs’ role in empathetically engaging with critical care patients has both positive and negative effects on their own self-care. Therefore, CCNs are encouraged to address and practice professional self-care strategies in the ICU [19]. Reflective supervision can help supervisors provide guidance and support to enable effective work in the ICU [3]. The researcher selected the concept of reflective supervision because it plays a crucial role in creating a positive practice environment in ICUs and improving the professional well-being of CCNs [20,21]. Clarification of the ambiguities related to the concept is necessary to ensure that ICU supervisors have a clear understanding of the theoretical definition of reflective supervision. This will help apply the concept in real-life situations, using examples provided in the model, as well as borderline and contrary cases.
2. Methods
2.1. Concept analysis method
Walker and Avant’s steps were followed to explore the conceptual analysis of reflective supervision as a professional self-care strategy for creating a positive ICU environment [22]. The steps are as follows: select a concept, determine the aims of the analysis, identify all uses of the concept of reflective supervision, determine the defining attributes, identify the model case, identify a borderline case and contrary case, define antecedents and consequences of reflective supervision, and define the empirical referents of reflective supervision [22]. Step one: The researcher analyzed the concept of reflective supervision as a professional self-care strategy in the ICU. Step two: Determine the purpose of examining the concept of reflective supervision in the ICU practice environment. Step three: All the uses of the concept of reflective supervision were identified and differentiated from other related concepts. Step four: The nine essential attributes of reflective supervision were identified. Step five: The researcher presented a model case of reflective supervision as a professional self-care strategy in an ICU environment, utilizing all the identified attributes from Step four. Step six: This step highlighted the borderline and the contrary cases. The borderline case of reflective supervision, whereby not all the attributes of reflective supervision were applied in the ICU environment, while a contrary case clarified the opposite of the model case. Therefore, all the attributes of reflective supervision in the ICU practice environment were not applied in the contrary case. Step seven: This step identified six antecedents, which are referred to as events that occurred before the concept of reflective supervision, and the consequences of utilizing reflective supervision in the ICU practice environment. Step eight: The empirical referents were explained in detail to measure the concept of reflection supervision in the ICU practice environment.
2.2. Search strategies
A comprehensive literature search was conducted to identify relevant English-language articles published between 2005 and 2025 on the concept of reflective supervision as a professional self-care strategy in the ICU environment. The search included multiple databases: Google Scholar, CINAHL, and PubMed. The combined search strategy that included free and MeSH terms along with Boolean operators (“AND” and “OR”) was as follows: (reflective supervision OR clinical supervision OR reflective practice) AND (professional self-care OR self-care OR nurses wellbeing) AND (positive icu environment OR practice environment OR nursing work environment) AND (concept analysis). A detailed search string for the databases was included in Appendix A.
2.3. Inclusion and exclusion criteria
The inclusion criteria for the selected studies were as follows: articles written in English, full-text, peer-reviewed articles from all source types (academic journals, books, conference reports, and dissertations/theses relevant to the study), with references and abstracts, published between 2005 and 2025 and related to the identified attributes, antecedents and consequences of reflective supervision. The duplicate studies were excluded.
2.4. Study selection and data extraction
All retrieved studies were exported in Research Information Systems (RIS) format to Mendeley Reference Manager. Imported records were organised by author, year of publication, title, abstract, and full text to facilitate the selection of eligible studies. Duplicate records were removed, and the study selection process was documented using a flowchart in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement [23,24]. The data extraction and analysis of the literature were performed independently by one author.
3. Results
A total of 1,447 English-language studies published between 2005 and 2025 reporting reflective supervision as a professional self-care strategy to create a positive ICU practice environment were retrieved from electronic databases. We removed 760 records before screening. During the screening process, 611 records were excluded, and an additional 36 records were removed following eligibility assessment. Consequently, 687 records were screened, while 76 records were assessed for eligibility. A total of 40 records [1,3,5,8,9,13,15,18,20,21,[25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54]] were included in the analysis (Fig. 1). Thirteen studies were literature reviews, two were case studies, twenty-one were empirical studies, and four were other types of records. The highest number of publications was from the social work discipline, with twenty papers, followed by nursing with fourteen papers. The other six publications were from other healthcare professionals, such as doctors, psychologists, and mental health care supervisors. The documents retrieved were mainly from the United Kingdom (UK) (n = 17), followed by the United States of America (USA) (n = 12), Australia (n = 3), African countries (n = 2), and others from Asia (n = 2), Canada (n = 2) and the Netherlands (n = 2). The detailed characteristics of the included studies were shown in Appendix B.
Fig. 1.
PRISMA 2020 flow diagram for reflective supervision in ICU.
3.1. Identifying all uses of the concept of reflective supervision
Professional self-care is an emerging area of concern that is becoming increasingly necessary in healthcare services, promoting both wellness and professional development [9,25]. Professional self-care can be defined as skills and strategies employed by CCNs to maintain their own personal, emotional, and spiritual needs while attending to the patient’s needs and demands [18,26]. In ICUs, professional self-care activities might include attending professional development workshops/training, seeking quality supervision, participating in peer support activities, setting appropriate patient boundaries, and advocating for personal needs in the ICU environment [9] This study focused on reflective supervision as a professional self-care strategy to support CCNs in their challenging, stressful practice environment in the ICU [25]. The supervisor’s purpose is to assess inexperienced supervisees over a period while simultaneously enhancing their professional functioning [27]. Reflective supervision is further defined as a component of professional self-care in the ICU and an ethical requirement for CCNs to critically reflect on their work, mitigate stress, and ensure competency in clinical practice [28]. Furthermore, reflective supervision reduces compassion fatigue and increases job satisfaction and organizational commitment by helping CCNs cope with environmental stress in the ICU [9,29,30]. Less experienced essential nurses of care utilize their supervisors' knowledge and experience to address knowledge gaps, thereby improving their clinical performance and professional development [31].
3.2. Other related concepts
Reflective supervision in the ICU is often used interchangeably with other concepts, such as reflective practice, clinical supervision, and reflective teaching, to enhance the health, well-being, and resilience of CCNs. The interchangeable concepts are shown in Fig. 2 below. Heffron et al. [32] and Shea et al. [33] all agreed that reflective practice used during clinical supervision in the ICU is referred to as reflective supervision. The differences between these concepts are that reflective practice emphasizes the individual, while reflective supervision emphasizes concern for both the supervisor and the supervisee [34]. Reflective practice is recognized as an essential and effective professional self-care strategy that serves as a foundation for professional development, enabling individuals to make meaning from the experiences of patients in ICUs. Reflective practice transforms insights into practical strategies for personal growth and organizational impact. Self-care is positively impacted, and CCNs gain the ability to care for themselves both personally and professionally. Reflective practice improves their emotional health and job satisfaction [18,35]. Other studies argue that reflective supervision is a distinct form of clinical supervision, characterized by its emphasis on embracing reflective practice and employing reflection strategies [35]. Reflective teaching is another concept used interchangeably with reflective supervision, referring to learning as a means of engaging in reflective supervision [36].
Fig. 2.
Concepts used interchangeably with reflective supervision.
3.3. Determining the defining attributes
Attributes are essential characteristics of a concept. The following nine attributes in Table 1 were identified in the concept analysis of reflective supervision: supervisor-supervisee relationship, effective communication, teamwork, reflection, competencies, feedback, continuous support, autonomous choice, and collaboration.
Table 1.
Attributes of reflective supervision in an intensive care environment.
| Attributes | Categories |
|---|---|
| Supervisor-supervisee relationship |
|
| Effective communication |
|
| Teamwork |
|
| Collaboration |
|
| Reflection |
|
| Competencies |
|
| Feedback |
|
| Continuous Support |
|
| Autonomous choice |
|
A good interpersonal relationship between a supervisor and a supervisee is characterized by mutual respect and trust, fostering a welcoming ICU environment where the supervisee feels supported, which in turn determines the success of the interactive supervisory process [15,[37], [38], [39]]. Effective communication is a vital element of reflective supervision, which is also referred to as the foundation of a healthy work environment [15]. Effective teamwork is fostered through interprofessional collaborations, and during this process, the supervisor has the opportunity to observe the supervisee’s strengths and skills [39,40]. Peer reflection is essential for deepening shared learning and improving practice [35,41]. The supervisor’s expectations encourage and motivate the development of competencies, expertise, and skills, such as mindfulness, to improve performance [42]. Additionally, supervisors create a positive learning environment by questioning and providing timely, regular, and constructive feedback to assist CCNs in gaining insight and a better understanding of managing ICU patients [43]. Continuous feedback from the supervisors’ support team culture and ensure supervisor availability to the supervisees [44]. Adequate supervision encourages an atmosphere of trust and a feeling of peer support [45,46]. Autonomous choice is an enabler of reflective supervision, enabling supervisees to develop professionally and maintain their well-being [21,46].
3.4. Identifying a model case
The model case encompasses all identified attributes of a concept used to explain real-life situations in ICUs, facilitating a reflective supervision process and focusing on the application of these attributes to create a positive practice environmen. The researcher incorporated the supervisor-supervisee relationship, effective communication, teamwork, reflection, competencies, feedback, continuous support, and autonomous choice to develop a model, as well as described borderline and contrary cases below.
Ms. Jary, a 30-year-old nurse, was transferred to the trauma ICU during the COVID-19 pandemic. With no prior ICU experience, she was anxious and frustrated. She was assigned to Mrs. Tyran, an ICU specialist, for three months of supervision and mentorship (continuous support). Orientation and in-service programs introduced her to staff (communication, positive environment), patient care, ICU routines, equipment, and environment (interaction, supervisor-supervisee relationship). Training included ICU procedures, protocols, and multidisciplinary sessions (supportive measures, interprofessional collaboration, teamwork). Weekly meetings encouraged discussion of experiences, challenges, coping strategies, and lessons learned (reflection). Self-care, work-life balance, emotional intelligence, and competency assessments were reinforced, with immediate feedback. Participation in interprofessional meetings fostered communication, advocacy, and initiatives to improve patient care (autonomy). The model case shows that all attributes were applied, creating a supportive environment that enhanced professional self-care, confidence, independence, and morale.
3.5. Identifying a borderline case
The borderline case refers to a case that exhibits similarities in its attributes but does not possess all the defining qualities.
Mr. Hector, a professional nurse in an adult cardiothoracic ICU, was supervised by Mr. Sydney, an ICU-trained nurse with ten years of experience (interprofessional collaboration, interaction, supervisor-supervisee relationship). He was managing a post-thoracotomy patient scheduled for extubation. The patient was stable initially, but deteriorated during Mr. Hector’s tea break, and resuscitation by the multidisciplinary team was unsuccessful. Mr. Hector was called to a management meeting to review the incident (feedback, communication) for quality improvement. Mr. Sydney instructed him to write an incident report, noting that it would be reported to the South African Nursing Council. The patient's family requested disciplinary action against Mr. Hector.
The borderline case suggests that the supervisor failed to allow Mr. Hector to reflect on what might have happened, why it occurred, and what could have been done differently to prevent the incident from recurring.
3.6. Identifying a contrary case
A contrary case is the opposite of the model case, as it lacks all the attributes that are identified to define and understand the meaning of reflective supervision. A medication error occurred in the ICU, causing adverse effects to the patient. The supervisor addressed the incident, but poor communication and lack of feedback left the supervisee feeling inadequately oriented to ICU medication protocols. Orientation and in-service training records were missing. The supervisor-supervisee relationship was characterized by a lack of respect, limited collaboration, a lack of trust, and ineffective communication. This incident created tension in the ICU, negatively affecting teamwork, team morale, and the supervisor-supervisee relationship.
3.7. Defining antecedents of the concept
Antecedents are incidents that occur before the idea of reflective supervision emerges. The concept analysis identified antecedents related to reflective supervision including participation, supportive supervision, flexibility, open-door policy, training, and motivation.
3.7.1. Participation
Reflective supervision involves active engagement in reflective dialogues with other team members and is characterized by an open and participative environment. Supervisors listen to supervisees during dialogues and involve them in decision-making [42,47].
3.7.2. Supportive supervision
Supervisors support the supervisees in identifying their own challenges and achieving results. The process supports supervisees by helping them manage occupational stress, thereby increasing job satisfaction [1,47].
3.7.3. Flexibility
Flexibility is enhanced when supervisors adopt an open-door policy, fostering a positive work environment that allows supervisees to benefit from more needs-based supervision [8,46].
3.7.4. Open-door policy
The availability, accessibility, consistency, and approachability enable supervisors to practice an open-door policy, which is beneficial to the supervisee in ensuring adequate reflective supervision [39,46]. The regularity of scheduled reflective supervisory sessions is significant in creating a trustworthy relationship [35].
3.7.5. Training
Supervisors trained in reflective supervision learned to reflect at deeper levels and apply critical thinking to identify lifelong learners. Lack of supervisor knowledge and training creates doubts about performing supervisory roles and responsibilities [42,43].
3.7.6. Motivation
A lack of training in reflective supervisory skills can negatively affect a supervisor's motivation and self-esteem. Increasing supervisee participation in decision-making by allowing them to share their ideas enhances motivation and engagement [13,21].
3.8. Identifying the consequences of reflective supervision
The consequences are the effects resulting from the occurrence of reflective supervision in creating a positive practice environment for CCNs. Nine consequences of reflective supervision were as follows: promotion of resilience, autonomy, work-life balance, self-awareness, increased self-esteem, professional development, critical thinking, increased job satisfaction, and enhanced commitment.
3.8.1. Promotion of resiliency
Resiliency is a dynamic process that enables the supervisee to become aware of emotions such as anxiety, fear, and grief, especially in challenging times [41,48]. The supervisee thrives in their personal and professional environments by recovering and coping in stressful work situations, bouncing back from challenging and difficult circumstances [49].
3.8.2. Autonomy
Reflective supervision enables supervisors to perform other tasks autonomously and identify work that can be done interdependently with others. Working autonomously allows supervisors to develop a leadership style [1,5].
3.8.3. Work-life balance
Reflective supervision enables the supervisee to practice work-life balance and effectively communicate with the supervisor about prioritizing tasks [1].
3.8.4. Self-awareness
Reflective supervision fosters self-awareness, while strategies such as self-regulation help supervisees manage their workload and enhance emotional awareness. It also improves their self-perception, how others view them, and supports professional growth [18,20].
3.8.5. Increased self-esteem
Through reflective supervision, supervisees gain self-esteem and become independent. This independent role enables supervisees to recognize their abilities and potential, and acknowledge their achievements [1].
3.8.6. Professional development
Supervisees are empowered with the knowledge and skills to shape their competencies and ensure their own professional development. Reflective supervision facilitates the development of professional self-care skills by helping supervisees critically reflect on their work [3,39].
3.8.7. Critical thinking
Reflective supervision enhances the supervisor-supervisee relationship by encouraging problem-solving, critical thinking, and autonomous decisions. The supervisee develops the ability to recognize biases that affect decision-making and proposes solutions for corrective measures [50,51].
3.8.8. Inceased job satisfaction
Increased job satisfaction results from the effective application of reflective supervision, whereby CCNs are given responsibilities to implement nursing care [52].
3.8.9. Enhanced commitment
The goal of reflective supervision is to develop the supervisees’ capabilities, competencies, and long-term commitment to promote evidence-based practice [53].
3.9. Defining empirical referents of the model
Empirical referents measure the defining attributes that help understand the concept of reflective supervision as a professional self-care strategy in an ICU environment [22]. This study revealed that this process led to professional development, critical thinking, and the ability to make autonomous decisions.
3.10. Summary of the theoretical definition of reflective supervision
Reflective supervision in the ICU practice environment is a relationship-focused, collaborative supervisory process and a professional self-care strategy that enables reflection in a supportive, non-judgmental environment, promoting wellness, self-awareness, professional development, and quality care. The reflective supervisory process is a quality improvement approach that evaluates and monitors performance to ensure the delivery of high-quality patient care. This process also provides professional support for effective learning by ensuring that activities are carried out properly [54].
4. Discussion
This study clarifies the ambiguities, inconsistencies, and lack of a conceptual definition of reflective supervision as a professional self-care strategy for creating a positive practice environment in ICUs. The misinterpretations make it challenging to understand the application of the reflective supervisory process in the ICU practice environment. Despite its benefits in supporting CCNs, other studies regard reflective supervision as a form of managerial surveillance [2]. Several articles have indicated that the concept of reflective supervision is used interchangeably with other concepts, such as reflective practice, clinical supervision, and reflective teaching [34,36,41]. Reflective practice is a cognitive skill that involves assessing a situation by examining one’s awareness of values and beliefs. It encourages CCNs to learn from previous experiences by incorporating learning [42]. The study also highlighted the significance of integrating professional self-care strategies, such as mindfulness, into reflective supervision to increase supervisee reflections. Health professionals utilize the reflective supervision strategy to support the supervisee's well-being by increasing self-awareness and personal and professional development [20,51,55].
The information obtained from reflecting on this event would have assisted in developing a quality improvement plan to prevent future incidents similar to the one that occurred. The staff would be able to articulate learning from these reflections. Mr. Hector was not allowed to express his emotions, reflect on what had happened, and describe the events in a supportive environment. Instead, he was blamed and accused of negligence.
Losing a patient who was expected to be extubated is stressful, which is the reason why Mr Hector felt worthless, emotionally distressed, and anxious, with low morale and decreased self-esteem. ICU supervisors can assist supervisees in learning to develop, modify, and implement a work-life balance plan.
The supervisor mobilizes resources, including communication, reflection competencies, feedback, and continuous support, to create a positive ICU practice environment. The relationship phase involves mobilizing resources, which is crucial in creating a positive practice environment for reflective supervision. The Job Demands-Resources (JDR) Framework suggests that mobilizing resources has a positive impact on establishing a healthy work environment. This includes mobilizing job resources and personal resources to enhance the well-being of CCNs. The availability of job resources in ICUs plays a significant role in critical care and job satisfaction. Self-efficacy, optimism, and experience are personal resources that positively influence compassion satisfaction [56].
Despite that, the supervisee should make an autonomous choice to participate in the reflective supervisory process [57]. Participation in a reflective supervisory process in the ICU can result in either positive or negative impacts on the supervisee. BACP [28] and Chipu et al. [56] argued that, despite a trustworthy relationship, the effectiveness of reflective supervision involves the supervisee making an autonomous choice to participate in and practice professional self-care strategies.
Pereira et al. [57] support the notion that a relationship built on trust, mutual respect, shared responsibility, and open communication contributes to the effectiveness of creating a positive practice ICU environment. The supervisory relationship is a preparatory foundation that requires trust and openness, allowing the supervisee to feel comfortable practicing adequate reflective supervision. Creating this positive practice environment in the ICU enables the supervisee to feel secure, fosters collaboration, and teamwork with members of the multidisciplinary team. The positive ICU environment also encourages timely decision-making and autonomy [58]. Effective supervisors create a safe, secure, and nonjudgmental environment by being approachable and respectful in considering the interests and welfare of supervisees. Supervisees can discuss issues freely, maintain confidentiality, and identify their own emotional experiences [27]. Rothwell et al. [27] and Terry et al. [59] support the notion that adequate reflective supervision is characterized by supervisors communicating openly and providing regular feedback. Effective communication has a positive impact on both the supervisor and the supervisee [27,59]. This process facilitates teaching, learning, knowledge creation, and skills development, preventing barriers between the supervisor and supervisee. The supervisee integrates new experiences and develops self-awareness [43,59].
A well-structured reflective supervision creates a safe environment for sharing work-related concerns and experiences, thereby alleviating work-related burdens. This results in a reduction in professional isolation and burnout [43]. A positive environment is created to support inexperienced CCNs in transitioning to, establishing, and sustaining independent nursing practice [60]. According to Crane et al. [61], a positive practice environment provides continuous support and motivation, fostering creativity, ensuring effective communication, improving well-being, reducing turnover rates, and encouraging collaboration among employees.
5. Recommendations of reflective supervision in creating a positive ICU practice environment
Reflective supervision is highly recommended as a professional self-care tool in nursing education strategy to create a positive ICU environment and promote the wellness and professional development of CCNs. ICU supervisors should be trained in applying reflective supervision in the challenging, stressful ICU environment. Professional debriefing and peer briefing should be encouraged to facilitate reflective supervision as a professional self-care strategy in the ICU. The inclusion of reflective supervision in the nursing curriculum is beneficial for facilitating the transfer of learning from the classroom to clinical practice.
6. Limitations of concept analysis
The results of this concept analysis may be influenced by certain limitations, including the restriction of the literature search to studies published between 2005 and 2025, the inclusion of only English-language articles, limitations related to country publications and disciplines, and the researchers’ interpretation of the concept of reflective supervision. Most of the retrieved articles originated from the UK, with limited representation from regions such as Africa. The social work discipline authored the highest number of papers compared to the nursing discipline, and these results may impact the applicability in the ICU practice environment. This imbalance may introduce researcher bias and limit the global applicability of the findings. The majority of the included articles were derived from the social work discipline, with fewer contributions from nursing, which may lead to misinterpretation of the concept within the ICU context.
7. Conclusions
The concept analysis highlighted a lack of consensus in defining ambiguities related to reflective supervision. The study yielded a theoretical definition to aid ICU supervisors in understanding the meaning of reflective supervision and its application in promoting the health and wellness of CCNs. Reflective supervision is theoretically defined as a process of building a good supervisor-supervisee relationship characterized by trust, respect, openness, approachability, continuous support, motivation, good communication, and collaboration. A positive practice environment focuses on the interests of the supervisees and fosters creativity to strengthen, establish, and maintain an effective healthcare professional workforce. This results in increased self-awareness, higher self-esteem, enhanced flexibility, improved work-life balance, stronger teamwork and collaboration, professional development, and greater resilience. The findings of the concept analysis contribute to the body of knowledge in the nursing profession, and there is a need to develop models for reflective supervision that can be used in ICU environments. Future empirical research will focus on the impact of implementing reflective supervision in various ICUs, including Trauma, Cardiac, Cardiothoracic, Neuro, Respiratory, and General and the formulation of reflective supervision policies in the ICU practice environment.
CRediT authorship contribution statement
Mpho Grace Chipu: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing – original draft, Writing – review & editing.
Data availability statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Declaration of competing interest
No conflict of interest has been declared.
Acknowledgments
The researcher expresses sincere gratitude to Prof. E.W. Nel and Prof. Downing for their guidance and for introducing me to the principles of caring science theory. I also thank Ilke Hay for her expertise in editing this article.
Footnotes
Peer review under responsibility of Chinese Nursing Association.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.ijnss.2025.12.016.
Appendix A. Supplementary data
The following is the Supplementary data to this article:
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.