What should be the nurses primary goal during the termination phase of the nurse-client relationship?

The relationship develops through various stages. There are four phases of a therapeutic relationship through which the relationship between nurse and patient develops.

Phases of therapeutic relationship

Four phases of therapeutic relationship as follows:

1. Preinteraction phase
2. Introductory/Orientation phase
3. Working phase
4. Termination phase

1. Preinteraction phase

The Preinteraction phase starts when the nurse is given the responsibility to start a therapeutic relationship with a patient. It also includes the thought process, planning, and feeling of a nurse before the first meeting with the patient.

Nurses responsibility in preinteraction phase

• To become well known about own feelings, fear, and fantasies.
• Analyze professional strengthss and weaknesses.
• Collect information about the patient like demographic data, occupational data, etc.
• Prepare a plan based on the data before meeting.

Problems found in preinteraction phase

• To effectively analyze self.
• Anxiety
• Anger
• Depression
• Boredom

Keys to overcome problems in preinteraction phase

Nurses can take the help of senior experienced nurses to overcome anxiety, analyze self and identify the limitations.

2. Introductory/Orientation Phase

It is the first meeting of the nurse with her client (patient). In this phase, the main goal of nurses is to find out the cause of patients seeking help.

Nurses responsibility in Introductory/Orientation Phase

• Nurses establish rapport, gain trust and create a familiar situation in which the patient accepts the nurse.
• Nurse initiate effective communication.
• She collects all the data about clients’ feelings, emotions, strengths, and weaknesses.
• The nurse identifies major areas of the problem and plans for the interventions.
• The nurse discusses with the client how to solve the problem, they mutually set goals.

Problems found in Orientation Phase

• Both nurse and patient may have problems accepting each other as a unique individual.
• They may have trust issues between them.
• The problem may occur in mutually setting a goal.

Keys to overcome problems in Orientation Phase

• The nurse may find similarities and can relate to an incident of her own. In this case, she might consult her senior supervisor.
• The nurse must share her feelings freely without having fear of criticism.
• During a discussion with the client, a nurse may have an emotional attachment with the client. A wise supervisor can identify it and help the nurse to overcome it.

3. Working Phase

Most of the therapeutic interventional activities carried out in this phase. Nurse and patient act as a team to identify stressors of the patient and promote the development of insight.

Nurses responsibility in working Phase

• Gather more and more data of the patient to explore the stressors.
• Help the patient to promote coping mechanisms and develop insight.
• Let the patient understand his behavioral change by evaluating himself.
• Facilitate individual functioning, If the required nurse can modify it by discussing with the client.
• The nurse can evaluate the problems and redefine them.

Problems found in working Phase

• Sometimes patients test the nurse.
• Making an unrealistic goal can give frustration to both nurse and patient.
• Nurses’ live problems.
• Transference
• Countertransference
• Resistance behavior

Keys to overcome problems in working phase

• Discussion with supervisors and other staff regarding the problem faced in this phase.
• Nurses may find sometime that she is not having progress enough.
• Handing the resistances effectively.

4. Termination Phase

It is the most important phase of the relationship. The main aim of this phase is to bring a therapeutic end to the termination phase.

Nurses responsibility in termination phase

• Put reality of separation in front of the patient.
• Nurse and patient should mutually explore the feelings, emotions,s and related behavior.
• Evaluate the effectiveness of therapy and achievement of goals.
• Discuss future plans for meetings if required.

Problems found in termination phase

• Anger
• Punitive behavior.
• Depression
• Nurses unwillingness to implement any plan.

Keys to overcome problems in termination phase

• Nurses should be aware of patient feelings and capable of managing the situation.
• Encourage the patient to share his thoughts regarding the termination phase.
• Nurses can take the help of the supervisor to help the nurse preparing for the discharge of a patient.

Research article

1. A study conducted by Jesus Molina Mula and Julia Gallo Estrada found that a good nurse-patient relationship increases the satisfaction of the patient, decreases anxiety during the hospital stay, and improves quality. (1)
2. A literature review suggests competencies and professional attributes of the nurse help in gaining the trust of the patient. (1)

Conclusion

Nurse and patients go through various phases of therapeutic relationship. It helps them to understand each other, identify the problems of the patient, and the problem is solved through mutual understanding. It also increases patients satisfaction and reduces anxiety during a hospital stay.

Frequently asked questions

Four phases of therapeutic relationship are like followings:1. Preinteraction phase2. Introductory/Orientation phase3. Working phase

4. Termination phase