The relationship develops through various stages. There are four phases of a therapeutic relationship through which the relationship between nurse and patient develops.
Table of Contents
Phases of therapeutic relationship
Four phases of therapeutic relationship as follows:
Preinteraction phase
Introductory/Orientation phase
Working phase
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 inworking 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 intermination 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
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)
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
What are the 4 phases of therapeutic relationship?
Four phases of therapeutic relationship are like followings: 1. Preinteraction phase 2. Introductory/Orientation phase 3. Working phase 4. Termination phase
What is pre interaction phase in therapeutic relationship?
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.
What are the problems arise during pre interaction phase?
Problems of pre interaction phase are To effectively analyze self. Anxiety Anger Depression Boredom
How to overcome pre interaction phase problems?
Nurses can take the help of senior experienced nurses to overcome anxiety, analyze self and identify the limitations.
What is 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.
What are the nurses responsibility in 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.
What are the problems may arise 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.
What is 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.
What is 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.
What are the 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.
Hildegarde Peplau describes four sequential phases of a nurse-client relationship, each characterized by specific tasks and interpersonal skills: preinteraction; orientation; working; and termination.
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.
The working or middle phase of the relationship is where nursing interventions frequently take place. Problems and issues are identified and plans to address these are put into action. Positive changes may alternate with resistance and/or lack of change.
Establishing therapeutic environment. The roles, goals, rules and limitations of the relationship are defined, nurse gains trust of the client, and the mode of communication are acceptable for both nurse and patient is set.
Four phases of the nurse-patient relationship have been identified: preinteraction phase; introductory, or orientation, phase; working phase; and termination phase. Each phase builds on the preceding one and has specific tasks.
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The orientation phase is the period when the nurse and patients first meet and goals are set. The goal of the orientation phase is to build trust and respect. Next comes the working phase, which is the period when solutions are explored, tried, and evaluated.
The assessment phase is a critical component of the nursing process. Information gathered in this phase is used to establish a foundation upon which all patient care moving forward is established.
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Termination is the final stage of counseling and marks the close of the relationship. Termination is the counselor and the client ending the therapeutic alliance. The termination stage can be as important as the initial stage in that it is the last interaction many clients will have with the counselor.
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