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43.During which phase of the nurse-patient relationship can the nurse anticipate that identified patientissues will be explored and resolved?
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44.At what point in the nurse-patient relationship should a nurse plan to first address termination?
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45.A nurse introduces the matter of a contract during the first session with a new patient becausecontracts:
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46.As a nurse escorts a patient being discharged after treatment for major depression, the patient givesthe nurse a necklace with a heart pendant and says, "Thank you for helping mend my broken heart."Which is the nurse's best response?
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hope."Accepting a gift creates a social rather than therapeutic relationship with the patient and blurs theboundaries of the relationship. A caring nurse will acknowledge the patient's gesture of appreciation, butthe gift should not be accepted.47.Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship?
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48.A nurse explains to the family of a mentally ill patient how a nurse-patient relationship differs fromsocial relationships. Which is the best explanation?
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49.A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurseshould:
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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