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

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The client in the termination phase of the nurse-client relationship is being very confrontational. How should the nurse interpret this behavior?

Possible Answers:

The nurse has done something to offend the client

This behavior is common for a client in the termination phase

The patient should be admitted to the hospital

The treatment should revisit the working phase

Correct answer: This behavior is common for a client in the termination phase

Explanation: Confrontational behavior is very common for a client in the termination phase. The nurse should not assume that she offended the client, and further action in terms of therapy should not be addressed until completing the termination phase.

The nurse is in the orientation phase of the nurse-client relationship where the client has been sexually assaulted. During this phase, the nurse should:

Possible Answers:

Establish acceptance, trust, and boundaries

Identify themes of patterns of patient behavior and possible coping mechanisms

Explore personal ideas, stereotypes, and biases that my affect the nurse-client relationship

Actively listen to the client express his thoughts and feelings

Correct answer: Establish acceptance, trust, and boundaries

Explanation: During the orientation phase the nurse should establish acceptance, trust, and boundaries with the client, which will be built upon in later phases.

Acceptance, trust and boundaries are established during which phase of the therapeutic nurse-client relationship?

Possible Answers:

Preinteraction

Working

Termination

Orientation

Correct answer: Orientation

Explanation: Acceptance, trust, and boundaries are established in the orientation phase of therapy.

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The therapeutic nurse-patient relationship is at the core of nursing practice. When established properly, the relationship contributes to a patient’s health and well-being.

For this reason, nurses are accountable for establishing and maintaining therapeutic relationships with their patients, including maintaining appropriate professional boundaries.

It is also important to know that the relationship lasts as long as the patient needs nursing care. This means that no matter how short or long the time span, a therapeutic nurse-patient relationship is formed.

To make sure the patient’s needs are prioritized, nurses must understand that the following five components are always present in a therapeutic nurse-patient relationship:

Trust:

Trust is critical to the therapeutic relationship. It may be fragile at first, and you need continual effort to maintain it.

Respect:

To respect is to recognize that every individual has inherent dignity, worth and uniqueness, regardless of socio-economic status, personal attributes and the nature of their health problem.

Professional Intimacy:

When nurses provide intimate care activities to their patients, such as bathing, it creates professional closeness. Professional intimacy can also involve being privy to psychological, spiritual and social elements that are identified in patients’ plans of care.

Empathy:

A nurse shows empathy by understanding, validating and confirming what the health care experience means to the patient. Nurses must ensure that they maintain appropriate emotional distance from the patient to ensure objectivity and an appropriate professional response.

Power:

The nurse-patient relationship is one of unequal power. The nurse has more authority and influence in the health care system, access to confidential information and the ability to advocate for the patient. If a nurse misuses this power, it is considered abuse.

Nurses’ responsibility to establish and maintain the therapeutic nurse-patient relationship also includes maintaining proper boundaries. This means that nurses must not engage in any behaviour or activity that could be perceived as violating a boundary. Violating a boundary means a nurse is misusing their power and trust in the relationship to meet personal needs or is behaving in an unprofessional manner with the patient.

Page 11 of the Therapeutic Nurse-Client Relationshippractice standard has a decision tree which helps to determine whether an activity or behaviour is appropriate within the context of the nurse-patient relationship and meets a therapeutic purpose. For more information about nurses’ accountabilities to their patients, read the Code of Conduct.

It is also important to be aware of the differences between professional and social relationships. Nurses must make sure they set appropriate boundaries that prevent a professional relationship from becoming a social one. For more information, read the Ask Practice FAQ: Professional versus social relationships.

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