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
Test Prep
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Question 15 out of 5 pointsWhich of the following activities would be a part of the planning phase of the nursing process?
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Question 22.5 out of 5 pointsWhich of the following are true concerning pain? Select all that apply.
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Question 35 out of 5 pointsWhich attitude on the part of the nurse is likely to result in accurate and complete subjectivedata collection?
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Question 42.5 out of 5 pointsWhich action would be the best for the nurse at the beginning of the nurse client encounterfor a client visiting a walk in clinic for complaints of a fever?
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temperatureCorrectAnswer:Subjective data collectionResponseFeedback:The best answer is to find out what the patient has to say about why he mayhave the fever and how long it has lasted, and how he feels. Then get the tempand other vitals. You get 1/2 credit if you answered take the vitals. The mostimportant thing to remember is that history turns out to be the most important
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