PHASES OF INTERPERSONAL RELATIONSHIP

A vital characteristics of nurse patient relationship is the sharing of behaviors, thought and
feelings. Peplau (1962) identified tasks of the relationship. The interpersonal relationship is
the means by which the nursing process is implemented.
Tasks of the relationship have been categorized into 4 phases
o The pre interaction phase
o The orientation or introductory phase
o The working phase
o The termination or resolution phase

1.THE PRE INTERACTION PHASE

The pre interaction phase begins before the nurse’s first contact with the patient. Here
preparation for the first encounter with the client. It begins before the nurse’s first contact
with the patient. A common fear of nurse related to the stereotype of psychiatric patient as
violent. Because this is the picture portrayed by the media many nurses are afraid of being
physically hurt by the patient’s outburst of aggressive behavior. Other fear is related to nurses
questioning their own mental health status. Nurses may fear mental illness and worry that
exposure to psychiatric patients might cause them to lose their own needs. Other task of this
phase include gathering data about the patient if information is available and planning for the
first interaction with the patient.
Task
 Obtaining available information from case sheet, chart, significant others and other
health team members.
 Initial assessment is begun.
 Prepare self for working activity.

2.THE ORIENTATION PHASE

The introductory contract between client and nurse first meet. It is the introductory phase that
the nurse and first meet. One of the nurses concerns is to find out why the patient sought help
and whether it was voluntary.
Formulating Contracts
The tasks in this phase of relationship are to establish a climate of trust, understanding,
acceptance and open communication and formulate a contract with the patient.
The Elements Of A Nurse-Patient Contract
 Name of the individual
 Role of nurse and patient
 Responsibilities of nurse and patient
  Expectations of nurse and patient
 Purposes of the relationship
 Meeting location and time
 Condition for termination
 Confidentiality
Exploring Feelings
Both the nurse and patient may experience some degree of discomfort and nervousness in the
introductory phase.
Reasons Patient Have Difficulty Seeking Help:
It may be difficult to see or admit one’s difficulties, first to oneself and then to another.
It is not easy to trust or be open with strangers.
Sharing personal problems with another person can threaten one’s sense of independence ,
autonomy and self esteem.
Solving problems involves thinking about something that may be unpleasant, viewing life
realistically, deciding on a plan of action and then carrying out whatever it takes to bring
about a change.
Other Tasks Of The Nurse In The Orientation Phase Of The -Relationship Include The
Following:
 To explore the patients perceptions, thought, feelings and actions.
 To identify the pertinent patient problem.
 To define mutual, specific goal with the patient.
Task
 Introduction of nurse and client.
 Creating an environment for the establishment of trust and rapport.
 Establishing a contract for interventions.
 To explore the patients perceptions, thought, feelings and actions.
 To identify the pertinent patient problem.
 To identify the clients strength and limitations.
 Formulating nursing diagnosis.
 Setting goals.
 Developing a plan of action.

3.THE WORKING PHASE

Most of the therapeutic work is carried out during the working phase. Most of the therapeutic
work is carried out during the working phase. The nurses helps the patient to master
anxieties, increase independence and self responsibilities and develop constructive coping
mechanisms. Actual behavior change is the focus of this phase. As the relationship develops
the patient begins to feel close to the nurse.
Task
 Maintaining the trust and rapport.
 Promoting the client’s insight and perception of reality.
 Develop realistic self concepts and promote self confidence.
 Develop a plan of action, implement the plan and evaluate the result of the plan.
 Help the client to change her/him dysfunctional behavior.

4.TERMINATION OR RESOLUTION PHASE

During this phase, learning is maximized for both the patient and the nurse. Reasons for
termination are the client may be discharged from the hospital, in the case of a student nurse,
it may be the end of a clinical rotation.
Termination is one of the most difficult but most important phase. It is the time to exchange
feelings and memories and to evaluate mutually the patients progress and goal attainment.
Criteria for determining patient readiness for termination:
 The patient experiences relief from the presenting problem.
 The patients functioning has improved.
 The patient has increased self esteem and a stronger sense of identity.
 The patient uses more adaptive coping responses.
 The patient has achieved the planned treatment outcomes.
Together the nurse and patient review the progress made in treatment and attainment of
specified goals. Feelings of rejection, sadness, loss and anger are expressed and explored. It
may be helpful to prepare the patient for termination by decreasing the number of visit,
incorporating other meetings.
Task
 Bringing a therapeutic conclusion to the relationship.
 Focus on the future.
 Provide necessary referral to others on the health tam.
 A plan for continuing care
 Feelings about termination of relationship are recognized and explored.