termination and Supervision Flashcards
Decision to terminate can be - 3
Nurse initiated
Family initiated
Context initiated - death, discharge, transfer
Nurse initiated
May occur before problem is resolved BUT
– suffering is diminished
– able to master/live alongside problem
– increased awareness/healing
– increased knowledge/expertise
In acute care often it means you are handing off care to another shift (ie. You’re now off work for 7 days)
When does termination occur?
- New solutions discovered that change family functioning
- Nurse and family have decided collaboratively further meetings not needed
- When the service is no longer approved by health care
Skills Phasing out
Review contracts
Decrease frequency of sessions
Give credit for change
Evaluate family interviews
Extend an invitation for follow up
Closing letters
2 risk factors for early family termination
1) families who miss the first meeting are at high risk for dropping out over the course of treatment
2) Families who are referred by institutions (such as a school or court) are more likely to discontinue treatment before achieving treatment goals than families who were individually referred (such as by physicians or mental health professionals).
Family Initiated Termination
“there are times when termination is inevitable…it is reasonable and ethical to accept the family’s initiative to terminate and do so without applying undue pressure, even though the nurse may disagree with their decision”
Acknowledge and review
progress made
problems remaining
goals might yet be achieved
when family decided
what prompted
who agrees/disagrees
anticipated benefit
Learning from premature termination
hypothesize re: contributing factors
When to Decrease Frequency of Sessions
When adequate progress has been made, as evidenced by reduced suffering, the time is ideal to begin to decrease the frequency of sessions
when the nurse has inadvertently fostered undue dependency
Context Initiated Termination
- death, discharge, transfer
- Initiated by health-care system or insurance company.
- Assess strengths/needs for further service
- Skills to facilitate referral
consolidation interview -
- the nurse asks particular questions to review the process of the work that the family and clinician have done together and then discusses the work the family seeks to accomplish on its own in the future
Reasons for nurses to refer families to other professionals
- for consultation or ongoing treatment in complex cases
- when the family moves
- is transferred to another setting
- is discharged before treatment is over
Closing Letters
- send the family a letter giving a summary of the family sessions
- provides the opportunity to highlight the family strengths, reinforce the changes made, offer the family a review of their efforts and what they have accomplished, and list the ideas (interventions) that were offered to them
Boundaries
- Who participates and how
- May be diffuse, rigid or permeable
- Clear permeable boundaries allow appropriate flexibility
- Are subject to culture, race, social class etc.
- Boundaries change over time – especially when there is a significant addition or loss within a family
poor boundaries
- Oversharing
- Concern with what people think so they can’t make decision
- People pleasing behavior
- Focus on others needs at the cost of their own
- Expressing a loss of self-absorbing or mirroring others emotional state
- Resentment and anger towards others
Maintaining boundaries when you are not in a position of power
- Setting boundaries works when the other person has something to lose or they genuinely care about your own boundaries
- Set boundaries in advance not during escalation
- When they violate the boundary…Do not shame or blame them
- Take the responsibility on yourself (often this means an apology) and then offer an alternative
Boundaries Brene Brown
what’s okay and what’s not okay
