Clinical Supervision and Positive Practice Environments: A Scoping Review

Abstract

Introduction

The purpose of clinical supervision (CS) is to assist healthcare providers in performing effective professional activities and providing the best care for patients, which has been described as associated with improved performance and quality indicators. Additionally, CS was found to be beneficial for the mental health of healthcare professionals in terms of their job satisfaction, levels of stress, and burnout.

Objective

The aim of the study was to map and synthesize existing evidence on how CS has been associated with positive practice environments for healthcare teams.

Methods

Scoping review was conducted in accordance with the Joanna Briggs Institute guidelines. Searches were conducted in July 2024 using CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, Scopus, and Web of Science. Both primary research and review studies were considered, as well as relevant gray literature. Studies were included if they addressed CS in relation to positive practice environments, well-being, or work conditions among healthcare teams. Data were analyzed thematically and through content analysis.

Results

This review included 37 studies, highlighting eight key categories: (i) mental health promotion; (ii) organizational culture; (iii) supervisor qualities; (iv) performance; (v) professional development; (vi) leadership/management; (vii) job satisfaction; and (viii) communication.

Conclusion

The findings indicate that CS is frequently described in the literature in relation to professional competencies, workplace well-being, psychological safety, job satisfaction, and communication within healthcare teams.

Introduction

Clinical supervision (CS) can be defined as a formal process of professional support and learning that enables healthcare practitioners to develop competence, assume responsibility for their practice, and enhance the safety and quality of patient care [1]. This review focuses on nurses and physicians working in diverse healthcare settings, including hospitals and primary healthcare. Across these settings, the healthcare sector is inherently demanding, requiring robust support systems to ensure that health teams can operate efficiently and effectively while preventing occupational distress and maintaining professionals’ well-being [2]. To guarantee this, CS has been described in the literature to positively influence healthcare organizational outcomes; therefore, investing in high-quality supervision practices is essential to maximize these benefits since the magnitude of its effect may vary according to contextual and implementation factors [3]. Martin et al. [3] highlighted the positive effect of CS on burnout, staff well-being, job satisfaction, job retention, and workplace environment. Similarly, Best et al. [4] proposed a predictive model linking clinicians’ satisfaction with the quality and structure of supervision, emphasizing that supportive and consistent supervisory relationships enhance workplace well-being. Also, supervision strategies have demonstrated empirical support for improving formative outcomes [5]. Furthermore, Rothwell et al. [6] identified key enablers and barriers to effective supervision, such as trust, clarity of purpose, and organizational support, which are critical to sustaining positive practice environments. The workplace environment is understood as the set of characteristics of the work context that facilitate or constrain professional practice [7]. On the other hand, positive psychology studies the conditions and processes contributing to the flourishing or optimal functioning of people, groups, and institutions [8], enhancing employee well-being and performance and diminishing stress, burnout, depression, and anxiety [9].

Supervision theory has started to delineate the characteristics of effective supervision models, including regular feedback, clear communication, emotional support, and opportunities for professional development [10]. In addition to improving professional competence, CS is described as associated with reducing psychosocial risks, such as emotional exhaustion, moral distress, and burnout, by providing a structured environment for reflection and peer support [11]. These benefits are indirectly associated with patient safety through improved communication, emotional regulation, and collaborative decision-making [12]. Despite the recognized importance of effective supervision, there is still a lack of consensus on the optimal supervision model for fostering a positive work environment for healthcare teams [6].

The positive psychology frameworks, such as those proposed by Seligman [13], emphasize the role of strengths, resilience, and well-being in professional contexts. Clinical supervisors who adopt a strength-based approach focus on recognizing and nurturing the inherent strengths and competencies of their supervisees [14].

Healthcare organizations present enablers and barriers to effective CS, which should be addressed. These enablers included having a set place and a regular time slot for supervision and flexibility, the supervisory relationship has to be based on a positive relationship and mutual trust, and it needs to have a shared understanding of its purpose [6]. Not considering these aspects becomes a barrier to effective CS.

Despite the growing body of research on CS, the literature remains fragmented, with considerable variation in definitions, models, and implementation strategies across healthcare contexts. Previous systematic reviews have largely focused on supervision outcomes or specific professional groups, leaving a limited understanding of how CS is described in relation to positive practice environments within healthcare teams [3, 5, 15].

A scoping review is therefore appropriate to provide a comprehensive overview of the available evidence, clarify how this relationship has been conceptualized in the literature, and identify existing knowledge gaps. By synthesizing the current evidence, this review may inform healthcare administrators, policymakers, and educators about how supervision practices are discussed in relation to supportive work environments and professional well-being.

Accordingly, this scoping review aimed to map and describe the extent and nature of existing evidence concerning CS and its relationship with positive practice environments in healthcare settings. Based on this aim, the review was guided by the following research question: how is CS described in the literature in relation to positive practice environments in healthcare settings? In order to address this question, the review pursued the following objectives: (i) to map the existing evidence regarding CS in healthcare teams and its relationship with positive practice environments; (ii) to examine how the literature conceptualizes the relationship between CS and workplace well-being and organizational conditions; and (iii) to identify gaps in the current evidence regarding the role of CS in positive practice environments.

Methods

A scoping review was conducted in accordance with the JBI methodology for scoping reviews [16] and the protocol published in Open Science Framework (DOI: 10.17605/OSF.IO/EUJ53). The mnemonic Population, Concept, and Context was considered when constructing the investigation question: how is CS described in the literature in relation to positive practice environments in healthcare settings?

Population, Concept, and Context

The population of interest included healthcare professionals working within healthcare teams, particularly nurses and physicians in clinical settings. Studies focusing exclusively on students or educational supervision contexts were excluded.

The central concept of this review is CS. In this review, CS refers to structured professional support processes aimed at facilitating reflection, professional development, and quality improvement in clinical practice. The review considers studies describing supervision models, frameworks, strategies, or practices implemented within healthcare teams.

The context of interest is positive practice environments within healthcare settings. Positive practice environments are understood as organizational conditions that support safe, effective, and healthy workplaces for healthcare professionals. These conditions may include factors such as leadership support, teamwork, communication, professional development opportunities, job satisfaction, and psychological well-being. Studies conducted in any healthcare setting (e.g., hospitals, primary care, community care) were considered eligible provided they addressed CS in relation to organizational or workplace environment conditions.

Inclusion Criteria

Studies were included if they (i) addressed CS within healthcare teams; (ii) examined organizational, professional, or psychosocial aspects related to workplace environments; and/or (iii) reported outcomes or contextual factors related to positive practice environments. For the purposes of this review, and in line with JBI methodological guidance [16], frameworks refer to conceptual or theoretical models used to structure or interpret CS processes; strategies refer to organized or planned approaches to implementing supervision within healthcare teams (e.g., structured programs, interventions, or models of delivery); and practices refer to specific activities or procedures occurring within supervision sessions (e.g., reflective discussions, feedback, or case review). These categories were used as analytical lenses to facilitate the organization and comparison of the included studies, rather than as mutually exclusive classifications. Studies were included when they reported outcomes or contextual factors related to workplace environments or organizational conditions relevant to positive practice environments. The identification of “positive practice environments” was not limited to the field of positive psychology; studies framed within organizational behavior, occupational health, or safety culture were also included. Outcomes representing positive practice environments included indicators such as job satisfaction, professional well-being, psychological health, teamwork, leadership support, communication, organizational culture, and workplace safety.

Eligibility Criteria

Eligible sources included empirical studies, reviews, and conceptual papers addressing CS in healthcare contexts. Both intervention studies and observational studies examining organizational factors related to CS were considered eligible.

No language or publication date restrictions were applied. However, the search strategy was conducted using English keywords, which may have limited the retrieval of studies published in other languages, despite the use of controlled vocabulary terms (e.g., MeSH and CINAHL headings). Studies focusing exclusively on student supervision or educational placements were excluded. For paywalled science or subscription-based access articles, a request message was sent to the authors. If a complimentary copy was not provided, the article was excluded.

Search Strategy

A three-step search strategy was used in this review. First, an initial limited search of MEDLINE (PubMed host), Scopus, and Scholar Google was undertaken to identify articles on the topic. The text words in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a full search strategy. The search strategy incorporated a combination of terms related to positive psychology and working conditions to capture studies addressing well-being and positive practice environments. In addition, studies examining CS within broader organizational, occupational, or cultural frameworks were included to ensure a comprehensive representation of the topic, regardless of their specific theoretical orientation. While the review did not impose explicit language restrictions, the search strategy employed English keywords, which may have limited the retrieval of non-English studies. Nonetheless, the MeSH and CINAHL headings were used to minimize this bias. The search strategy, including all identified keywords and index terms, was adapted for each included database (Table 1). The search was conducted on July 23, 2024, and the databases used include MEDLINE (PubMed host), CINAHL (EBSCO host), Cochrane Database of Systematic Reviews (EBSCO host), Scopus, and Web of Science.

Table 1.

Search strategy

Database	Host	Boolean search syntax used	Filters used	Records retrieved
MEDLINE	PubMed	((((positive psychology) OR (Psychology, Positive[Mesh])) OR (Working Conditions[Mesh])) OR ((work* condition*) AND (work* condition*))) AND (((clinical supervision) OR (Preceptorship[Mesh])))	None	14
CINAHL	EBSCO	CINAHL (EBSCO) 113 (((MH “Positive Psychology”) OR “positive psychology” OR (MH “Work Environment+”) OR “working environment”) AND ((MH “Clinical Supervision+”) OR “Clinical Supervision”))	Academic journals	113
Cochrane Database of Systematic Reviews	EBSCO	(((MH “Positive Psychology”) OR “positive psychology” OR (MH “Work Environment+”) OR “working environment”) AND ((MH “Clinical Supervision+”) OR “Clinical Supervision”))	None	0
Scopus	Scopus	(ALL (“clinical supervision”) OR ALL (preceptorship) OR ALL (“preceptorship model”) AND ALL (“positive psychology”) OR ALL (“work* condition*”))	Article or review	616
Web of Science	Web of Science	(((AK=(“clinical supervision”)) OR AK=(preceptorship)) AND AK=(“positive psychology”)) OR AK=(“work* condition*”)	​	14

The search strategy was developed iteratively based on an initial exploratory search of the literature, consultation of controlled vocabulary terms (MeSH and CINAHL headings), and identification of relevant keywords used in previously published studies. The concept mapping exercise also supported the identification of frequently occurring terms, which informed the refinement of the final search strategy.

Following the search, all identified citations were uploaded into Zotero 6.0.37 for macOS [17], and duplicates were removed. Following a pilot test, titles and abstracts were screened by two independent reviewers to assess compliance with the review’s inclusion criteria. Of these, 603 records were excluded during title and abstract screening. The main reasons for exclusion were (i) studies not focused on CS (n = 346); (ii) studies addressing only student or educational supervision (n = 119); studies not related to workplace or organizational outcomes (n = 83); studies conducted in unrelated professional contexts, such as social work, psychology, or allied health (n = 48); and studies lacking sufficient empirical or conceptual content (n = 7).

Potentially relevant sources were retrieved in full text, and their citation details were imported into Zotero. The full text of selected citations was assessed in detail against the inclusion criteria by two independent reviewers. Any disagreements that arose between the reviewers at each stage of the selection process were resolved through discussion or with an additional reviewer. The results of the search and the study inclusion process are presented as a PRISMA flow diagram [18] in Figure 1, which describes the study selection process for the scoping review. A total of 758 records were identified through database searches, including MEDLINE (14), Scopus (616), CINAHL (113), and Web of Science (14). After removing 21 duplicate records and one retracted article, 735 records remained for title and abstract screening. Of these, 603 records were excluded. A total of 132 reports were sought for retrieval, and 131 full-text articles were assessed for eligibility. One article could not be retrieved despite contacting the authors. Among the full-text articles assessed, 94 were excluded for the following reasons: participants were not nurses or physicians (31), participants were students (12), the study did not address supervision strategies (27), the study did not address positive work environments (16), or the report type was excluded (7). Finally, 37 studies met the inclusion criteria and were included in the review.

Fig. 1.

Preferred Reporting items for systematic reviews and meta-analysis diagram.

Data Analysis and Presentation

Data extracted from the included studies were analyzed using a combination of inductive and deductive coding, following the principles of thematic and content analysis [19]. Deductive codes were initially derived from the predefined categories identified in the concept map created with VOSviewer 1.6.20 for macOS [20] and research objectives (e.g., supervision processes, professional well-being, organizational culture), while inductive codes were generated from recurring patterns and themes that emerged from the data extraction matrix designed by the researchers using MAXQDA24 [21].

A codebook was developed iteratively: initial codes were created during the preliminary analysis of five studies, refined through constant comparison, and subsequently grouped into higher order categories representing key dimensions of how CS is reported in relation to positive practice environments. Coding was conducted independently by two reviewers, who then met to compare and reconcile their coding decisions. Inter-coder agreement was assessed through discussion and consensus rather than statistical calculation, as the emphasis was on conceptual alignment. Any discrepancies were resolved through joint review and refinement of code definitions.

To ensure trustworthiness and rigor, several strategies were employed: (i) triangulation of data sources and reviewers, (ii) peer debriefing within the research team, and (iii) reflexive consideration of potential biases throughout the analytic process. The final thematic synthesis was validated through iterative comparison with the extracted data to confirm internal coherence and representativeness. Triangulation of data and sources was used to compare findings across different study designs, healthcare contexts, and reported outcomes. This process allowed the identification of recurring concepts, themes, and categories related to the role of CS in positive practice environments.

In addition, the distinctions among frameworks, strategies, and practices were used to support the classification of the extracted data, allowing differentiation among conceptual models, implementation approaches, and specific supervision activities described in the included studies. This categorization contributed to the organization of the data prior to the development of the final thematic categories.

Results

To explore the conceptual landscape surrounding CS and positive practice environments, a concept map was developed using VOSviewer software [20]. The map, presented in Figure 2, was generated from all full-text articles retrieved during the initial exploratory search. Keywords and key terms were analyzed according to their frequency and co-occurrence patterns, allowing the visualization of clusters of concepts that frequently appear together in the literature. This mapping does not represent a theoretical model or explanatory framework. Rather, it provides a descriptive visualization of how key terms related to CS and workplace environments co-occur within the existing literature. The objective of this step was to obtain an overview of the main themes addressed in the field and to support the refinement of the search strategy and inclusion criteria for the scoping review.

Fig. 2.

Concept map of keywords related to CS and workplace environments generated using VOSviewer. Colors represent thematic clusters identified through keyword co-occurrence analysis (e.g., red: implementation and intervention approaches; yellow: mental health and well-being; green: education and professional development; blue: supervisory relationship).

Several clusters of related terms emerged. One cluster includes terms related to supervision, reflection, and learning, reflecting the educational and developmental dimensions frequently discussed in studies of CS. Another cluster groups terms associated with job satisfaction, well-being, and burnout, indicating that psychosocial outcomes are commonly addressed in relation to supervision practices. A third cluster includes concepts related to leadership, organizational culture, and workplace environment, suggesting that supervision is often discussed within broader organizational contexts.

The 37 studies included in this review span from 1999 to 2024 and represent diverse healthcare contexts across Europe, Australia, Asia, Africa, and the Middle East. The predominance of research conducted in countries such as the UK, Australia, Finland, and Sweden reflects their long-standing traditions of CS implementation and evaluation. Most studies targeted nurses as the main population, with several also involving multidisciplinary teams including physicians, mental health practitioners, and allied health professionals. Sample sizes ranged widely, from small qualitative samples to large-scale quantitative or cross-sectional studies.

Table 2 shows the objectives and participants involved in each study, the methods, the CS interventions, and topics that are described in relation to positive practice environments, and their respective outcomes. Colors represent thematic clusters identified through keyword co-occurrence analysis (e.g., red: implementation and intervention approaches; yellow: mental health and well-being; green: education and professional development; blue: supervisory relationship).

Table 2.

Summary of the characteristics of the included studies

Author	Country of origin/context	Population/sample	Study design	Focus of supervision	Reported workplace outcomes
Berg and Hallberg [22]	General psychiatric ward in Sweden	22 nurses	Pre-post-test	Systematic CS and care planning	Creativity, improved organizational climate
Severinsson and Kamaker [23]	Public general hospital in Sweden	158 nurses	Descriptive-correlational study	CS and moral sensitivity	Reduced anxiety, improved work environment
Berg and Welander Hansson [24]	One ward of a psychogeriatric clinic in Sweden	13 nurses	Qualitative study	Group supervision and reflective support	Professional growth, improved relationships
Markey et al. [25]	Ireland	–	Specialist report	Supervision in mental health services	Job satisfaction, reduced work stress
White and Roche [26]	Mental health nursing services in Australia	601 mental health nurses and 17 Area Health Service	Scooping study	CS participation	Well-being at work, burnout prevention
Koivu et al. [27]	University hospital in Finland	166 female nurses	Quasi-experimental study	Supervision effectiveness	Job engagement and psychological well-being
Koivu et al. [28]	University hospital in Finland	304 female nurses	Survey	Supportive supervision practices	Staff motivation and performance
Bradley et al. [29]	Health team members of Malawi and Tanzania	Malawi: 20 interviews	Qualitative study	Content of supervision sessions	Quality and safety of care
		Tanzania: 37 interviews
Pearce et al. [30]	Australia	20 studies included	Systematic review	Supervision processes	Staff satisfaction, reduced burnout
Best et al. [4]	Professionals that working at an alcohol and other drug treatment center in Australia	43 clinicians, managers, and supervisors	Observational study	Mentorship programs	Reduced turnover, professional competence
Chen and Lou [31]	Taiwan	5 experimental and quasi-experimental studies that adopted mentorship programs as an intervention	Systematic review	Organizational support strategies	Job satisfaction, staff retention
Dawson et al. [32]	Medical and surgical nursing units in 3 hospitals in Australia	362 nurses	Cross-sectional study	Well-being at work framework	Leadership support, collaboration
Utriainen et al. [33]	Finland	Hospital nurses	Theoretical model	Emotional support through supervision	Emotional regulation, burnout reduction
MacLaren et al. [34]	Community mental health nurses in the UK	8 nurses	Qualitative study	Supervision experiences	Staff support and professional development
Allbutt et al. [35]	Health and social care practitioners in Scotland	8 practitioners from secondary and primary health and 4 social care services	Qualitative study	Coaching and workplace learning	Professional development
Faithfull-Byrne et al. [36]	Australia	One health service	Study case	Leadership and empowerment	Innovative work behavior
Masood and Afsar [37]	Public sector hospitals in Pakistan	587 nurses and 164 physicians	Cross-sectional study	Organizational mental health interventions	Well-being and engagement
Gray et al. [38]	South Africa	60 articles	Exploratory review	Organizational support for nurses	Thriving at work
Moloney et al. [39]	New Zealand	20 articles	Integrative review of literature	Workplace supervision and support	Job satisfaction
Morton et al. [40]	Private critical care unit in South Africa	40 nurses	Quantitative descriptive study	Resilience-based supervision	Emotional intelligence and resilience
Stacey et al. [41]	Healthcare trusts in UK	266 newly qualified nurses	Pilot study	Reflective discussions	Team support and stress management
Delany et al. [42]	Australia	Clinicians	Narrative review	Interventions supporting coping	Stress management
Foster et al. [43]	UK	18 studies	Scooping review	Communication and difficult conversations	Team relationships
King and Williams [44]	Australia	20 clinical supervisors	Qualitative study	Organizational learning culture	Employee performance
Bhatti et al. [45]	Pakistan	306 trained health nurses	Cross-sectional and random sampling study	Workplace empowerment	Reduced incivility
Blackstock et al. [46]	Canada	22 included studies	Integrative review	Resilience strategies	Emotional well-being
Delgado et al. [47]	Australia	11 mental health nurses	Qualitative study	Mentorship relationships	Organizational commitment
Foster et al. [48]	Australia	12 nurses (23 stories)	Qualitative (narrative threads) study	Nurses’ well-being model	Work engagement
Gong et al. [49]	Six regional general hospitals in China	371 first-line nurses	Cross-sectional study	Restorative supervision model	Staff well-being
Xiao et al. [50]	China	98 articles focusing nurses’ well-being	Systematic literature review	Resilience narratives	Professional coping
Featherbe [51]	UK	NHS staff	Study case	Workforce retention factors	Job retention
de Vries et al. [52]	USA	345 articles	Systematic review	Leadership development	Professional competence
Alilyyani et al. [53]	Saudi Arabia	370 nurses and 249 interns	Mixed-methods study	Psychological well-being	Resilience and coping
Foster et al. [54]	Mental health service of a large hospital in Australia	144 nurses	Cross-sectional study	CS interventions	Job satisfaction
Hudays et al. [15]	Saudi Arabia	8 articles	Systematic review	Organizational support strategies	Workplace well-being
O’Connor et al. [55]	New Zealand	7 articles focusing nurses’ well-being	Integrative literature review	Systematic CS and care planning	Creativity, improved organizational climate

The supervision interventions identified in the included studies were highly diverse in structure, purpose, and theoretical orientation. Early studies [22–24] focused on systematic and structured supervision programs, emphasizing creativity, moral sensitivity, and emotional well-being among psychiatric nurses. Subsequent research expanded this scope to include reflective practice, mentorship, coaching, and resilience-based supervision, highlighting the adaptive evolution of CS as both a developmental and supportive tool.

Most interventions were designed around Proctor’s three functions of supervision (formative, normative, and restorative), although several studies [36, 41] introduced hybrid or context-specific models integrating coaching, resilience, or emotional intelligence training. Across studies, the reported outcomes consistently demonstrated associations with individual and organizational well-being [4, 15, 22–55]. At the individual level, supervision was associated with improved job satisfaction, reflective capacity, professional growth, stress management, and emotional resilience [4, 24–26, 28–30, 35–37, 39, 41, 43, 47, 48, 50, 52, 54, 55]. At the organizational level, supervision contributed to enhanced teamwork, communication, and supportive workplace culture, often reducing turnover intention and burnout [15, 23, 24, 31–34, 38, 40, 42, 45, 46, 49, 51].

Some studies also underscored systemic challenges, including time constraints, inconsistent managerial support, and lack of protected supervision time [35, 44, 49, 51], indicating that, despite the benefits, implementation remains uneven. Overall, the evidence highlights CS as a multifaceted intervention described in the literature in relation to both psychosocial well-being and organizational health, especially when aligned with supportive leadership, reflective practice, and a culture of open communication.

Using the VOSviewer software [20] to analyze all abstracts of the selected articles, we found the most commonly used terms, which are presented in Table 3, ranked by relevance. The term “Clinical Supervision” appeared as the most frequent keyword in the concept map (62 occurrences). This prominence reflects the focus of the review and the search strategy used to retrieve the literature. Closely associated terms such as professional development (28), experience (31), and support (18) further indicate that the literature conceptualizes CS primarily as a developmental and supportive process described in relation to reflective practice and competence among healthcare professionals. Another dominant cluster includes terms related to well-being and work outcomes, such as job satisfaction (17), well-being (17), stress (11), burnout (10), and resilience (25). This grouping reflects the strong emphasis on the restorative and protective functions of CS, particularly in relation to work-related stress, emotional resilience, and sustaining nurses’ psychological health. Also, a conceptual grouping highlights organizational and leadership dimensions, represented by terms such as transformational leadership (7), innovative work behavior (8), organizational commitment (5), and performance (10). These concepts suggest that CS is increasingly framed not only as a professional support mechanism but also as a strategic organizational tool related to motivation, engagement, and retention. All terms strongly related to CS are presented in Figure 3.

Table 3.

Most relevant terms found in abstracts

Term	Occurrences	Relevance	Term	Occurrences	Relevance
Organizational commitment	5	6.14	Nursing management	5	0.77
Mentoring relationship	6	5.75	Supervision	42	0.77
Transformational leadership	7	4.95	Professional development	28	0.76
Innovative work behavior	8	4.66	Experience	31	0.71
Turnover intention	7	3.20	Patient	8	0.66
Psychological distress	7	2.92	Workplace	17	0.50
Performance	10	1.82	Job satisfaction	17	0.40
Effectiveness	9	1.74	CS	62	0.35
Knowledge	8	1.56	Retention	11	0.30
Difficult conversation	12	1.24	Stress	11	0.26
Leadership skill	11	1.18	Well-being	17	0.25
Resilience	25	0.85	Burnout	10	0.19
Relationship	17	0.81	Support	18	0.17

Fig. 3.

Concepts related to CS.

This figure presents a keyword network map illustrating the relationships between CS and key concepts related to healthcare workplace environments. The term “CS” appears at the center of the network and is connected to multiple related concepts, indicating its central role in the literature. The map shows several thematic clusters organized around CS. One cluster relates to nurses and organizational aspects of healthcare work, including terms such as nurse, care, management, job satisfaction, and effectiveness. Another cluster focuses on mental health and occupational well-being, including psychological distress, resilience, turnover intention, and health professionals’ well-being. A third cluster highlights supervision processes and professional support, including supervision, retention, stress, and workplace support. Additional clusters represent professional development and learning, including skills, leadership, experience, and education, as well as relational aspects of supervision such as mentoring relationships and professional interactions. The lines connecting the nodes represent co-occurrence relationships between concepts in the literature, and the spatial proximity between terms indicates stronger associations. Overall, the network illustrates how CS is conceptually connected to themes related to professional development, workplace well-being, organizational support, and nursing practice in healthcare environments.

A further content analysis was performed using MAXQDA24 software, deductively identifying eight main categories and 24 subcategories of CS use described in relation to positive practice environments. The main categories include (i) mental health promotion; (ii) organization culture; (iii) supervisor qualities; (iv) performance; (v) professional development; (vi) leadership/management; (vii) job satisfaction; and (viii) communication. The subcategories include interventions and/or content that should be focused on CS. These results are presented in full in Table 4, which reports the number of occurrences and their frequencies, representing how often each category or subcategory was coded within the “supervision categories/interventions” column of Table 1 results.

Table 4.

Content analysis with frequency of categories and subcategories

Categories	Occurrences	Frequency	Subcategories	Occurrences
Mental health promotion	103	26.3%	Psychological distress prevention	46
			Interpersonal relationship	27
			Support	17
			Respect for individuality	8
			Appreciation	5
Organizational culture	55	21.9%	Working conditions	16
			Motivation and engagement	12
			Empowerment and autonomy	10
			Teamwork	9
			Opportunities to grow	6
			Team-building activities	2
Supervisor qualities	28	14.5%	Use CS models and tools	11
			Be communicative, supportive, team player, and appreciative	9
			Focus on improvement, teaching, and problem-solving	8
Performance	23	11.2%	Support safe and competent practice	15
			Assesses performance/quality of care	8
Professional Development	20	9.4%	Skill and competence development	11
			Training and education	9
Leadership/management	15	7.7%	Fair and supportive leadership	9
			Organizational support	6
Job satisfaction	10	4.6%	Promote most satisfying aspects of work	10
			Reduce most least satisfying aspects of work	4
Communication	9	4.3%	Promote effective communication within the team	6
			Use feedback	3

The categories most frequently reported were mental health promotion (26.3%) and organizational culture (21.9%), together accounting for nearly half of all extracted findings. The mental health promotion category encompasses outcomes related to psychological distress prevention (46 occurrences), interpersonal relationships (27), support (17), respect for individuality (8), and appreciation (5). This cluster includes terms related to restorative and psychosocial aspects of CS, which are frequently discussed in the literature in relation to stress and professional well-being. The second most frequent category, organizational culture, reflects the structural and contextual aspects of healthy work environments. Subcategories such as working conditions (16), motivation and engagement (12), empowerment and autonomy (10), and teamwork (9) indicate that CS is frequently discussed in the literature in relation to individual well-being.

The remaining categories – supervisor qualities (14.5%), performance (11.2%), professional development (9.4%), and leadership/management (7.7%) – underscore the mechanisms through which CS is described in the literature as being associated with. Effective supervision depends on competent, communicative, and supportive supervisors (9 occurrences), the use of structured models and reflective tools (11), and the capacity to focus on improvement, teaching, and problem-solving (8). These features are essential for ensuring both safe and competent practice and ongoing professional growth.

The less frequent yet conceptually significant categories – job satisfaction (4.6%) and communication (4.3%) – demonstrate that while these aspects are not always the main focus, they remain key indicators of positive organizational climate and interpersonal effectiveness. Subcategories such as promoting effective team communication and constructive feedback use illustrate the interpersonal foundations of supportive work environments.

Discussion

Key Findings

Because the included studies varied widely in design and methodological approach, the results should be interpreted as a descriptive synthesis of how CS has been conceptualized and discussed in relation to workplace environments in the literature. This scoping review provides a descriptive and conceptual mapping of how CS has been associated with positive practice environments across healthcare contexts. Rather than assessing intervention effectiveness or causality, the review identifies recurrent themes, conceptual framings, and practice domains reported in the literature. The clustering of the most used terms found in this review reflects the strong alignment between individual and organizational outcomes in the literature. From the thematic analysis of the results, we identify eight main categories, which are (in order of frequency) (i) mental health promotion; (ii) organization culture; (iii) supervisor qualities; (iv) performance; (v) professional development; (vi) leadership/management; (vii) job satisfaction, and (viii) communication. These results highlight what aspects of CS are most commonly emphasized, but they do not reveal how supervision leads to such outcomes. Findings are consistent with previous studies that emphasize the importance of supervisory relationships and organizational support when discussing supervision outcomes [3, 5, 6].

Mental Health Promotion and Well-Being

“Mental health promotion” was the category that appeared the most across the results. This category was divided into subcategories to better understand the different subjects that CS is described in relation to positive work environments: (i) psychological distress prevention; (ii) interpersonal relationships; (iii) support; (iv) respect for individuality; and (v) appreciation. “Psychological distress” includes problems such as stress [23, 30, 39, 40, 43, 48, 54], anxiety [23, 25, 31, 40, 43, 47], exhaustion [25, 26, 32, 39, 41, 43, 50, 52], burnout [4, 27, 28, 34, 42, 43, 52], and frustration [23, 25, 26, 54]. For instance, resilience training [25, 28, 34, 41, 43, 47, 48, 54, 55] and coping strategies [25, 33, 34, 37, 38, 40, 41, 43, 47, 54] were the most mentioned supervision interventions to prevent this. Healthcare practitioners’ resilience is a dynamic and complex process, with high levels of resilience being associated with reduced psychological distress and increased well-being [56]. This author stated that although resilience is predominantly focused on individual factors, the working environment and conditions can also affect it. In addition, Babanataj et al. [57] reported the effectiveness of a resilience training program in nurses’ resilience covering: (i) the concept of resilience and the characteristics of resilient people; (ii) internal supportive factors such as optimism and self-esteem; (iii) external supportive factors and social support; (iv) communication with others; (v) directing stress; (vi) being determined and hopeful about the future; (vii) self-awareness; (viii) self-confidence; and (ix) self-care. On the other hand, Velana and Rinkenauer [58] published a systematic review of coping strategies for job-related stress among nurses, including (i) technology-based interventions for stress management and mental health; (ii) mindfulness-based and spiritual interventions; (iii) cognitive-behavioral interventions; (iv) body-based interventions. The next subcategory found was the “interpersonal relationship,” which also impacts the professionals’ mental health and well-being [15, 22–24, 26, 33, 39–42, 50–52, 55]. This corroborates a systematic review stating that a strong interpersonal relationship is associated with psychological safety and leadership should build an effective culture that includes collaboration, trust, and frequent high-quality communication [59]. This leads us to “support” [22, 24, 25, 29, 31, 33, 35, 36, 38, 39, 44, 45, 47, 50, 51], as another subcategory of CS interventions that are associated with mental health, which is conducive to CS approach to professional development that creates a supportive space for healthcare workers to critically reflect on experiences relating to their work [60]. It is also important to “respect for individuality” [24, 35, 36, 49, 52, 55], confirming each professional as a unique person, respecting different ways to do a task, or promoting individual strengths within the team. The last subcategory of mental health promotion is “appreciation” [25, 29, 32, 40, 52, 53, 55]. This corroborates a study that confirmed not only the importance of appreciation for job satisfaction but also the mediation of this association through negative feelings of resentment toward the organization and protective feelings of success [61]. The predominance of outcomes related to mental health and well-being indicates that the literature frequently examines CS in relation to psychological distress and emotional well-being among healthcare professionals [62].

Organizational Culture and Workplace Conditions

“Organizational culture” also reflects patterns in the literature associating CS with positive environments. It is well stated that organizational culture and organizational trust affect job satisfaction and team-based practice [63]. The first subcategory that appears in this review is “working conditions” [15, 26, 31, 32, 39, 40, 46, 49, 50, 52], and that includes topics as workload, professional-patient ratios, flexible schedules, work-life balance, justice, salary pay, benefits, policies, adequate resources, and respect for rights. Although healthcare working conditions may be challenging, it is essential for a positive practice environment that affects job satisfaction, professional retention, team resilience, and care safety [64]. The second subcategory is “motivation and engagement” as a crucial aspect of a positive practice environment [23, 27–29, 38, 39, 48, 50, 52]. In this matter, Giamos et al. [65] suggested continuous performance feedback to improve motivation and task engagement, which is an important CS tool. On the other hand, “empowerment and autonomy” [23, 26, 37, 39, 46, 50], the third subcategory, can be improved by leaders and clinical supervisors using a strength-based nursing leadership, which specifically addresses issues of autonomy, agency, and empowerment grounded in the actual realities of nursing [66]. Promoting “teamwork” is also encouraged [15, 26, 33, 39, 42, 51]. “Opportunities to grow” [26, 31–33, 35, 39, 40, 51, 53–55] also appear as a subcategory that includes both personal, as opportunities for education and training, and professional development, like opportunities to embrace new tasks and positions, or throughout the career. The last subcategory that appears in organizational culture is “team-building activities” [38, 40]. Although less discussed in the studies included in this review, team-building activities are growing in popularity among organizations and have proven benefits in encouraging creativity and innovation, open communication, and increased collaboration [67]. Additionally, Rothwell et al. [6] emphasized that contextual enablers such as trust and shared purpose are essential for effective implementation. Findings related to organizational culture indicate that the literature frequently discusses CS alongside supportive, empowering, and motivating work environments.

Supervisor Qualities and Supervision Process

The next category, “supervisor qualities,” refers to aspects the clinical supervisor must address to assure the quality of the CS. In this category, three subcategories were identified. The subcategory “use CS models and tools” [15, 25, 35, 36, 43, 49, 51] recommends the conscious use of CS models and assessment tools and promotes the supervisor’s education and training. Several models of CS are utilized in practice settings with no universal consensus on what form it should take [6]. The next subcategory is self-explanatory and recommends the clinical supervisor to “be communicative, supportive, a team player, and appreciative” [4, 15, 25, 29, 31, 33, 45, 51–53, 55]. Finally, the subcategory “focus on improvement, teaching and problem-solving” signals the clinical supervisor’s role in continuous improvement, providing effective teaching and mentorship that promotes a growth-oriented environment that ensures high-quality healthcare [4, 25, 29, 31, 34–36, 53]. The emphasis on supervisor qualities and professional development indicates that well-trained, communicative supervisors are frequently described as important elements in discussions of positive practice environments. The emphasis on supervisor qualities reinforces the importance of skilled, communicative, and empathetic supervisors in facilitating effective supervision processes and maintaining trust and collaboration within the team.

Performance and Quality of Care

That leads us to the next category, which is “performance.” Healthcare workers’ performance has been strongly linked to psychological safety and job satisfaction [68]. In this category, two main subcategories emerged: “support safe and competent practice” [25, 26, 29, 31–36, 39, 42, 45] and “assess performance/quality of care” [29, 32, 34, 36]. CS is frequently described in the literature as a performance-enhancing tool, as it supports safe and competent practice while systematically assessing performance and quality of care to ensure adherence to professional standards through a normative function as used in the Proctor CS Model [25]. The association between supervision and performance outcomes is described in the literature in relation to clinical competence, safe care, and continuous quality improvement.

Professional Development and Learning

Health professionals’ practice performance and patient outcomes are increased by continuing “professional development” through both formal and informal activities [69], which is the next category that emerged through the thematic analysis. This includes “skill and competence development” [4, 26, 29, 31, 33, 36, 39, 42, 52, 53, 55] and “training and education” [4, 32, 35, 36, 40, 43, 45, 53, 55]. The incorporation of supervisory processes into practice as a strategy for continuous education and care improvement is a crucial component for fostering professional growth and elevating the quality of healthcare, as evidenced by a systematic review [70]. The recurring link between supervision and professional development indicates that CS functions as a key mechanism for reflective learning, skill advancement, and sustained professional growth.

Leadership and Organizational Support

CS and leadership are usually closely related, and CS is recognized as a method to enhance “leadership/management” skills, while work pressure, work environment, and poor communication are obstacles to developing these skills [53]. Also, leaders are indispensable in creating positive work environments, so positive and supportive leadership styles are associated with job satisfaction and organizational commitment, while simultaneously reducing emotional exhaustion [71]. Regarding this, two self-explained subcategories emerged: “fair and supportive leadership” [23, 33, 37, 39, 46, 49, 50, 53] and “organizational support” [39, 40, 47, 49, 51, 52]. The inclusion of leadership and management-related outcomes highlights that fair and supportive leadership is fundamental for embedding CS within organizational systems and ensuring its long-term sustainability [72]. Also, the presence of leadership-related concepts, including transformational leadership and organizational commitment, indicates a conceptual shift toward recognizing CS as a strategic component of healthy work environments rather than a solely supportive intervention [73].

Job Satisfaction and Work Engagement

It is known that workplace incivility has a negative influence on job satisfaction and subjective well-being [74]. To prevent this, literature links CS with “job satisfaction,” where two opposite subcategories emerged: “promote most satisfying aspects of work” [15, 22–24, 26–28, 32, 33, 39, 40, 43, 46, 50, 52, 54, 55]and “reduce the least satisfying aspects of work” [26, 29, 35, 55]. Among many others, a study identified that skill variety, task identity, performance feedback, autonomy, and job security have a significant positive correlation with job satisfaction [75]. Also, professional recognition, decision-making, and empowerment are positively linked to job satisfaction [76]. On the other hand, indicators of job dissatisfaction include hierarchical relationships; compliance with legal rules and bureaucracy; poor physical work environment; poor career development opportunities; lack of communication; work overload; conflict of roles and impaired interpersonal communication; burnout; emotional exhaustion, dehumanization; and disappointment at work [77]. All these corroborate that clinician satisfaction is strongly associated with structured, consistent, and supportive supervision [4]. In this sense, the connection between CS and job satisfaction indicates that supervision is often discussed to enhance positive perceptions of work by promoting rewarding experiences and reducing dissatisfaction factors such as workload or lack of recognition.

Communication and Team Dynamics

The last category is “communication.” It is important to “promote effective communication within the team” [4, 15, 33, 41, 43, 44, 49], and so it emerged as a subcategory. The last subcategory is “use feedback” [29, 49, 52], which is frequently discussed in relation to enhancing attention in clinical learning, helping in repairing faults, updates about their performance, and motivating for improvement [78]. Also, huddles are linked to have a predominantly positive impact on teamwork and job satisfaction [68], demonstrating to be a useful CS tool to use in health services and perfect opportunities for feedback and debriefings. The identification of communication as a distinct category reflects the centrality of open dialogue and feedback in building cohesive teams and creating psychologically safe workplaces that support learning and collaboration [79]. However, the lower frequency of explicit references to communication and job satisfaction suggests that these areas remain underexplored and merit further empirical investigation.

Integration of Themes: A Multilevel Perspective of CS

It is also important to interpret the frequency of the identified themes cautiously. The predominance of certain categories in this review likely reflects areas that have received greater attention in the literature rather than indicating their relative importance or effectiveness. Conversely, themes that appear less frequently may represent aspects of CS that remain underexplored and therefore warrant further empirical investigation.

Taken together, the thematic categories presented above reveal interconnections that extend beyond their individual descriptions, reflecting a broader structure of relationships consistent with the conceptual patterns identified through the VOSviewer analysis. This interconnectedness highlights that the themes are not isolated phenomena but rather complementary components of a unified framework through which CS can influence workplace dynamics. The themes suggest that CS operates as a multilevel process integrating individual, relational, and organizational dimensions. At the individual level, categories such as mental health promotion, job satisfaction, and professional development illustrate how CS supports psychological well-being, reflective learning, and skill enhancement. At the relational level, themes like communication, teamwork, and supervisor qualities emphasize the importance of trust, open dialogue, and constructive feedback within supervisory relationships. Finally, at the organizational level, leadership/management and organizational culture point to the systemic conditions that enable supervision to become a sustained mechanism of workforce support. When viewed collectively, these dimensions reflect a dynamic and interconnected system rather than isolated effects. The conceptual model developed in this review reinforces this interpretation by visually demonstrating the clustering of terms related to well-being, leadership, and professional development around CS. This interconnection indicates that the literature frequently discusses CS alongside multiple dimensions of workplace environments, including personal, interpersonal, and organizational factors.

Literature links the effectiveness of CS to the application of evidence-based frameworks, such as Proctor’s model [62], and supervisors’ relational and reflective competencies, including communication, empathy, feedback provision, sensitivity, ethical consideration, and critical reflexivity [29, 41, 49, 51, 80]. These findings align with the conceptual model developed in this review, which situates supervision as a multilevel process that simultaneously fosters individual well-being, strengthens interpersonal dynamics, and consolidates organizational culture. Moreover, recent literature emphasizes the importance of supervisors integrating reflective practice and emotional intelligence principles to support more resilient, cohesive, and adaptive healthcare teams [39, 47, 81]. This convergence between empirical and conceptual evidence strengthens the interpretation of CS as a strategic intervention for sustaining positive practice environments.

Additionally, Ryu et al. [82] defended that for CS to be truly effective, it must be embedded within a supportive organizational culture that addresses the broader systemic challenges affecting the nursing workforce. For these authors, supervision alone cannot resolve structural issues such as workload, staffing shortages, or limited managerial support; rather, it should operate alongside organizational strategies that promote fair working conditions and psychological safety [82].

Synthesis of Findings according to Review Objectives

In relation to the objectives of this review, the findings can be summarized as follows. First, regarding the mapping of existing evidence, the literature on CS in healthcare teams is heterogeneous, encompassing qualitative, quantitative, and review studies that address a wide range of individual, relational, and organizational dimensions of workplace environments. Second, concerning the conceptualization of the relationship between CS and positive practice environments, the literature consistently describes supervision in relation to themes such as mental health and well-being, organizational culture, professional development, and leadership, indicating a multidimensional understanding of its role. However, these conceptualizations are predominantly descriptive and vary across contexts, with no unified theoretical framework guiding the field. Third, in relation to gaps in the evidence, the predominance of qualitative and cross-sectional designs, the limited use of longitudinal or experimental approaches, and the underrepresentation of certain themes, such as communication and job satisfaction, suggest that important aspects of this relationship remain insufficiently explored. These findings highlight the need for more robust and theory-informed research to clarify how CS is operationalized and examined across healthcare settings.

Implications for Practice and Limitations

This review provides insights into how CS is described in the literature in relation to positive healthcare practice environments. An important limitation of this review relates to the nature of the scoping review methodology itself. Scoping reviews aimed to map and describe the existing body of literature rather than evaluating the effectiveness of interventions or establishing causal relationships between variables. Consequently, the findings presented in this review should be interpreted as patterns in the literature rather than evidence of the effectiveness of CS in improving workplace outcomes. While causal inferences cannot be drawn, the recurrence of certain themes suggests that CS is consistently conceptualized as a multidimensional process encompassing support, reflection, and professional growth. This consistency across studies indicates conceptual convergence in how CS is perceived to contribute to positive work environments, even if the mechanisms remain insufficiently examined. The comprehensive search strategy applied across multiple databases, combined with well-defined eligibility criteria, was essential in ensuring the consistency and clarity of the findings. A potential language bias should be acknowledged, as the search strategy was conducted in English. Although no language restriction was used, the exclusive use of English keywords may have restricted the retrieval of non-English records, even using MeSH and CINAHL headings.

The predominance of qualitative and cross-sectional studies suggests that the field remains largely interpretive, emphasizing perceived outcomes and experiential insights rather than causal inference. This points to the need for future research employing stronger evaluative designs to better capture the mechanisms through which CS fosters positive practice environments.

However, in multicultural work environments, no single CS model or approach is considered equally effective for employees, since each team and each individual have unique expectations and perceptions. Therefore, no single CS model can be assumed to operate in the same way across all healthcare teams. The range of CS interventions and tools identified in this review illustrates the diversity of approaches described in the literature across different healthcare contexts. Another limitation of this study is that no existing CS model includes all these categories. These findings may contribute to future conceptual work aimed at developing supervision models that explicitly address positive practice environments and may also inform discussions among healthcare leaders, managers, and educators regarding the potential role of CS within workplace environments. Additionally, these insights may support reflection among healthcare teams regarding supervision practices and workplace environments. The wide range of supervision models identified across countries and professional groups reflects the adaptability of CS to diverse healthcare contexts.

Conclusion

This scoping review mapped and synthesized the existing literature on CS in relation to positive practice environments in healthcare settings. The findings indicate that CS is consistently described in the literature in relation to professional development, workplace well-being, organizational culture, leadership, and communication, reflecting a multidimensional and context-dependent conceptualization of its role.

Rather than demonstrating effectiveness or causal relationships, the review highlights how CS is framed across studies as a process associated with individual, relational, and organizational dimensions of healthcare work. The predominance of qualitative and cross-sectional designs suggests that the current evidence base remains largely descriptive, with limited capacity to explain mechanisms or assess impact.

The variability in definitions, models, and implementation approaches identified across studies further indicates the absence of a unified framework guiding CS practices in relation to positive practice environments. In addition, the unequal distribution of themes across the literature suggests that some areas, such as mental health and organizational culture, are more extensively explored, while others, including communication and job satisfaction, remain comparatively underdeveloped.

While it is widely recognized that no single CS model is applicable across all contexts, the findings of this review indicate that no existing model explicitly integrates all the categories identified in relation to positive practice environments. These results highlight the need for further research to explore these dimensions, improve conceptual clarity, and examine how supervision processes are described across different healthcare settings. Additionally, these findings may inform future discussions among policymakers and healthcare leaders regarding how CS can be framed and implemented within organizational contexts. This review provides a comprehensive mapping of the existing evidence; however, its scope was influenced by the specificity of the search terms, which may have limited the inclusion of studies framed within broader organizational perspectives.

Statement of Ethics

This study is based exclusively on published literature and therefore does not raise any ethical issues.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Funding Sources

This study was not supported by any sponsor or funder.

Author Contributions

All authors were involved in the design, data collection, data analysis, drafting, and revising of the work. All authors approved the final manuscript.

Funding Statement

This study was not supported by any sponsor or funder.

Data Availability Statement

All data analyzed during this study are included in this article and its online supplementary material (for all online suppl. material, see https://doi.org/10.1159/000552254). Further inquiries can be directed to the corresponding author.