Chapter 10 – The Three Phases of the Nurse-Client Relationship

In the nursing profession, establishing a nurse-client relationship involves several phases. According to Peplau, the nurse-client relationship consists of four phases that are sequential in nature. These phases are called the orientation, working, and termination phases. The orientation phase is the first. In this phase, the nurse introduces himself to the client and explains the purpose of the relationship. The nurse will ask the client about himself, his family, and the circumstances that brought him/her to the hospital. The nurse will also prepare the client for the termination phase of the relationship. The following are some of the stages in the nurse-client relationship.

Orientation Phase – Pre-interaction

The pre-interaction phases of the nurse-client relationships begin with the orientation phase, when both the nurse and client get acquainted with one another. The task of this phase is to build a relationship of trust and acceptance, set goals, and gather assessment information. Orientation also involves exploring feelings and expectations between the nurse and client. The working phase follows, where both the nurse and client work together to achieve the goals.

The first contact between nurse and client occurs in the pre-interaction phase, in which the novice nurse must explore his or her self. The first clinical experience in nursing can be stressful and challenging, and novice nurses are likely to bring misconceptions about the public and fears about themselves. New experiences lead to feelings of anxiety, ambivalence, and uncertainty, which are normal reactions to such an experience.

Introduction

An Introduction to the Nurse-Client Relationship begins with the introduction phase, which sets the tone for the whole relationship. This phase involves establishing rapport, communicating boundaries, explaining your role, and discussing your client’s desired outcome. It also involves evaluating your own biases and the patient’s condition. Identifying what the nurse can and cannot do can help you and the patient decide which therapeutic interventions to use.

A therapeutic nursing interaction can foster growth and insight, and the nurse and client work toward solutions that benefit both parties. Throughout the entire process, nurses must possess self-awareness and a philosophical belief. They must be patient-centered and nonjudgmental. A rapport-based relationship fosters a mutual trust and respect between the nurse and the client. The therapeutic relationship also promotes behavioral change.

Working phase

Once a client is comfortable with the nurse, the working phase involves identifying the client’s problem, exploring solutions, and evaluating these solutions. The client’s sense of security and safety is established, and the nurse and client develop an understanding of each other’s roles and responsibilities. The working stage also includes the development of a positive self concept, communication, and assuming different roles. The nursing relationship can be challenging, but it’s not impossible.

In the working phase of the nurse-client relationship, the nurses build rapport with their clients, establish their role, and collect data about their clients. At the same time, the nurses are collecting data on their clients, facilitating effective communication. The clients also learn about the nurse’s role and their rights. After this phase, the relationship will move into the termination phase. It is critical that the nurse and the client agree on what their mutual goals are.

The working phase of the nurse-client relationship focuses on the process of establishing trust and addressing problems. Positive changes are common, but sometimes there is resistance and a lack of change. The nurse’s role in the working phase of the nurse-client relationship is to promote change.

The nurse should identify the factors that contribute to a client’s progress in the working phase. These include perceived attitudes of the nurse, the nature of the therapeutic sessions, and the things that happen between sessions. The working phase demonstrates supportive aspects of the relationship, whereas the ending phase involves mutual withdrawal. The client and the nurse have different perspectives on what constitutes a supportive relationship. The nursing role is to help the client establish a healthy balance between the two.

When the nurse and the patient complete their mutual goal, the working phase of the nurse-client relationship ends. The client and the nurse discuss changes in their health and their responses to these changes. They also discuss any emotional or physical responses to these changes. At the beginning of the working phase, the nurse establishes a rapport and trust. As the relationship progresses, the nurse attends to the physical health care needs of the client while developing solutions for the client’s emotional and psychological needs.

The working phase of the nurse-client relationship involves identification of client problems, evaluating solutions, and applying these solutions to improve the client’s quality of life. In the working stage, the nurse and client work to create a positive self-concept for each other and to promote coping mechanisms. The working stage also involves communication, establishing different roles, and exploring emotional feelings and responses. The working phase of the nurse-client relationship focuses on building trust between the client and nurse.

The orientation phase involves establishing a climate of acceptance, trust, and contract between the nurse and the client. During this time, the nurse will explain his or her role, discuss the patient’s expectations, and formulate nursing diagnoses. Lastly, the nurse and the client discuss their feelings and develop a problem-solving model. After the orientation phase, the working phase takes place, where the nurse and client work together to achieve the client’s goal.

An Introduction to the Nurse-Client Relationship focuses on how nurses interact with patients, which is considered the core of nursing. The synthesis of theory describes the nurse-patient relationship as a bond of energy, a spiritual connection, and a living reality. A life-giving, compassionate, and meaningful nurse-patient relationship is one of the highest quality connections. Developing a life-giving relationship requires that both the patient and the nurse work together to help the patient and the nurse succeed in achieving their goals.

Throughout the patient-nurse interaction, nurses should maintain an open posture, demonstrating that they are receptive to the patient. A closed posture suggests a defensive posture. Leaning forward shows that the nurse is focused on the interaction and is interested in the client’s needs. This shows that the nurse is focused and attentive. An open posture also shows that the nurse is genuinely interested in the client’s interaction.

Implementation

In the implementation of the nurse-client relationship, nurses must first clarify the nature of the relationship. The client is at a crossroads because they may be distancing feelings from a past person. To counteract this, the nurse should help the client separate the past person from the present self. The priority nursing action should be to develop treatment goals, seek alternative placement, and explore thoughts about the client. This phase is particularly important if the patient feels sadness, dejection, or frustration.

During this phase, the nurse must build rapport with the client and create a comfortable and familiar situation. The nurse should then collect data about the patient’s health and analyze the problem areas, plan interventions, and communicate expectations. The nurse and client may have difficulty setting goals or establishing trust. Once the nurse has established the basic framework, the relationship should evolve further. This phase is especially critical in mental health nursing. For example, the nurse should explain the nurse’s role and the client should be aware of his or her rights and responsibilities.

The nurse-client relationship is the foundation of nursing practice. It is therapeutic in nature and focuses on the needs of the client. It requires the appropriate use of authority and respect, and abides by the standards of ethics. It must be accompanied by appropriate boundaries between professional and personal behavior. Further, it must ensure the client’s dignity. A nurse must never be seductive or demeaning. If the nurse is engaging in inappropriate communication, it may not be a healthy environment.

In addition to building rapport with the client, the nurse should also establish boundaries between them and the nurse. It is essential to communicate the client’s needs and role, establish boundaries, and adhere to them. The nurse-client relationship should be successful in all phases. The client’s long-term health is the nurse’s responsibility. A healthy and productive termination is vital to the success of the nurse-client relationship. There are also several guidelines that a nurse should follow when terminating the relationship.

Termination Phase

The final phase of the nurse-client relationship is known as the termination phase. This phase is the most important phase of the nurse-client relationship. It is the time when the nurse and patient exchange feelings, evaluate their progress toward the goals, and discuss the future of their relationship. This stage of the nurse-client relationship also involves evaluating the effectiveness of therapy and planning future meetings. During this phase, the nurse should monitor the patient’s reactions and be able to handle the situation appropriately. If necessary, a supervisor should help if needed.

The termination phase is very important because you as the clinician do not want to be with the patient any longer than is necessary. Learning to terminate the interaction is key in managing your time as nurses tend to have many other things to do.