At what point in the nurse-patient relationship should a nurse plan to first address termination group of answer choices?

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Orientation:

In the beginning of the therapeutic relationship, the nurse and client are strangers to each other, yet each individual has preconceptions of what to expect – based on previous relationships, experiences, attitudes and beliefs
The parameters of the relationship are established (e.g., place of meeting, length, frequency, role or service offered, confidentiality, duration of relationship)
The client and nurse begin to learn to trust and know each other as partners in the relationship
Trust, respect, honesty and effective communication are key principles in establishing a relationship

Working Phase:

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
It is important for the nurse to validate thoughts, feelings and behaviours
The nurse assists the client to explore thoughts (e.g. views of self, others, environment, and problem solving), feelings (e.g. grief, anger, mistrust, sadness), and behaviours (e.g. promiscuity, aggression, withdrawal, hyperactivity)
The content to be explored is chosen by the client although the nurse facilitates the process
The nurse continues his/her assessment throughout all phases of the relationship
New problems and needs may emerge as the nurse-client relationship develops and as earlier identified issues are addressed
The nurse advocates for the client to ensure that the client’s perspectives and priorities are reflected in the plan of care

Resolution Phase:

The resolution or ending phase is the final stage of the nurse-client relationship
After the client’s problems or issues are addressed, the relationship needs to be completed before it can be terminated
The ending of the nurse-client relationship is based on mutual understanding and a celebration of goals that have been met
Both the nurse and the client experience growth
Termination may be met with ambivalence
The nurse and the client must recognize that loss may accompany the ending of a relationship
Both should share feelings related to the ending of the therapeutic relationship
Validating plans for the future may be a useful strategy
Increased autonomy of both the client and the nurse is observed in this phase

Psychiatric Nursing (Notes)

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The nurse and the client work together to assist client to grow and solve his problems. This relationship exists for the benefit of the client so that it is important that at every interaction, the nurse uses self therapeutically. This is achieved by maintaining the nurses’ self-awareness to prevent her unrecognized needs from influencing her perception of and behavior towards the client.

Three Phases of Nurse-Client Relationship:

1. Orientation Stage

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.
- Acceptance is the foundation of all therapeutic relationship
- Acceptance of others requires acceptance of self first.
Rapport is built by demonstrating acceptance and non-judgmental attitude.
Acceptance of patient means encouraging the patient verbally and non-verbally to express both positive and negative feelings even if these are divergent from accepted norms and general viewpoint.
- The nurse can encourage the client to share his/her feelings by making the client understand that no feeling is wrong.
Trust of patient is gained by being consistent.
Assessment of the client is made by obtaining data from primary and secondary sources.
The patient set the pace of the relationship.
During this phase, the problems are not yet been resolved but the client’s feelings especially anxiety is reduced, by using palliative measures, to enable the client to relax enough to talk about his distressing feelings and thoughts.
This stage progresses well when the nurses show empathy provide support to client and temporary structure until the client can control his own feelings and behavior.
- Reality testing – is accepting the patient’s perceptions, feelings and thoughts as neither right nor wrong, but at the same time offering other options or points of view to the client in a non-argumentative manner for the purpose of helping the client arrive at more realistic conclusions.
- To provide structure is to intervene when the client loses control of his own feelings and behaviors by medications, offering self, restrain, seclusion and by assisting client to observe a consistent daily schedule.

2. Working/ Exploration/ Identification Stage – at this point, the client’s problems are identified and solutions are explored, applied and evaluated.

The focus of the assessment and of the relationship is the client’s behavior and the focus of the interaction is the client’s feelings.
The nurse should realize that the client’s feelings of security are developed by being consistent at all times.
Perception of reality, coping mechanisms and support systems are identified.
The nurse assists the patient to develop coping skills, positive self concept and independence in order to change the behavior of the client to one that is adaptive and appropriate.
- The nurse uses the techniques of communication and assumes different roles to help the client.

3. Termination/ Resolution stage

the nurse terminates the relationship when the mutually agreed goals are met, the patient is discharged or transferred or the rotation is finished. The focus of this stage is the growth that has occurred in the client and the nurse helps the patient to become independent and responsible in making his own decisions. The relationship and the growth or change that has occurred in both the nurse and the patient is summarized.
Client may become anxious and react with increased dependence, hostility and withdrawal, these are normal reactions and are signs of separation anxiety, these feelings and behavior should be discussed with the client.
The nurse should be firm in maintaining professionalism until the end of the relationship. She should not promise the client that the relationship will be continued.
The time parameters should be made early in the relationship and meetings are set further and further apart near the end to foster independence of the patient and prepare the latter gradually for the separation.
The nurse should not give her address or telephone numbers to the patient.
Referral for continuing health care and support after discharge provides additional resources for the client and the family.
The goal of the therapeutic relationship have been met when the patient has developed emotional stability, cope positively, recognized sources or causes of anxiety, demonstrates ability to handle anxiety and independence, and is able to perform self-care.
- Preparation of the termination phase begins at the orientation phase, when the duration and length of the nurse-client relationship was established.
- · It is normal for the client to experience separation anxiety such as sleeplessness, anorexia, physical symptoms, withdrawal and hostility.