Phases of Nurse – Patient Interaction

PRE-INTERACTION PHASE
- Before meeting the client, the nurse:
• Review available data including the medical and nursing history
• Talks to other caregivers who may have information about the client.
• Anticipate health concerns or issues that may arise.
• Identifies a location and setting that will foster comfortable private interaction.
• Plans enough time for the initial interaction.

ORIENTATION / INITIATION PHASE
- When the nurse and client meet and get to know one another, the nurse:
• Sets the tone for the relationship by adopting a warm emphatic caring manner.
• Recognizes that the initial relationship may be superficial, uncertain and tentative.
• Expects the client to test the nurse’s competence and commitment
• Closely observes the client and expects to be closely observed by the client.
• Begins to make inferences and form judgments about client messages and behaviors.
• Assesses the client’s problems and identifies the client’s goals.
• Clarifies the client’s and nurse’s roles.
• Forms contracts with the client that specify who will do what.
• Lets the client know when to expect the relationship to be terminated.

WORKING PHASE
- When the nurse and client work together to solve problems and accomplish goals, the nurse:
• Encourages and helps the client with self-exploration.
• Provides information needed to understand and change behavior.
• Encourages and helps the client to set goals.
• Takes action to meet the goals set with the client.

TERMINATION PHASE
- During the ending of the relationship, the nurse:
• Reminds the client that termination is near
• Evaluates goal achievement with the client
• Reminisces about the client by relinquishing responsibility for his or her care.
• Achieves a smooth transition for the client to other caregivers as needed.
• Nurse and client express thoughts and feelings about the termination.
• Observe client – high level of anxiety during this phase, exhibited such:
 Hostility
 Disparagement of relationship
 Hallucinations, delusions
 Regressive behaviors
 Recall of other separation experiences