During which phase of the nurse-patient relationship do the nurse and the patient work together to establish goals?

Appeared in: BTSC 3 August 2025

Explanation

The Orientation phase is the introductory stage of the therapeutic relationship.
During this phase, the nurse and patient get to know each other, build trust, and define the purpose and boundaries of their interactions.
A critical task of the orientation phase is to assess the patient's health status, identify problems, and mutually establish the goals that will guide the care plan.
This phase culminates in a 'contract,' which can be verbal or written, specifying the roles of both the nurse and patient and the agreed-upon goals.

Option B: The Termination phase occurs at the end of the relationship. Its purpose is to evaluate the achievement of goals that were set earlier, not to establish new ones.
Option C: The Pre-interaction phase happens before the nurse has any direct contact with the patient. The nurse is gathering information and planning for the first meeting, so no mutual goal setting can occur.
Option D: The Working phase is when the nurse and patient actively collaborate to achieve the goals that were already established during the orientation phase. The focus is on action and problem-solving, not initial goal setting.

Clinical Relevance

Nursing practice connection: Use the key finding related to Phases of the Nurse-Patient Relationship to guide bedside assessment, documentation, and the next nursing action.
Properly establishing goals in the orientation phase is crucial for patient-centered care. It ensures the patient is an active participant in their health journey, which increases motivation and adherence to the care plan.
A failure to set clear, mutual goals can lead to a disjointed working phase, patient dissatisfaction, and poor health outcomes.
What if? If a patient is non-verbal or has cognitive impairments, the nurse must adapt their approach during the orientation phase, possibly involving family members or using alternative communication methods to establish goals and a plan of care.

How to Approach the Question

First, identify the core concept of the question, which is the 'nurse-patient relationship' and its phases.
Next, focus on the key action verb in the question: 'establish goals'.
Recall the four phases of the therapeutic relationship as defined by Hildegard Peplau: Pre-interaction, Orientation, Working, and Termination.
Mentally review the primary purpose of each phase.
Match the action 'establish goals' to the correct phase. The Orientation phase is for introductions and setting the plan, the Working phase is for carrying out the plan, and the Termination phase is for concluding the plan.
Select the option that corresponds to the phase where planning and goal-setting occur.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 2 p. 115-117

E6 Nursing Fundamentals Taylor p. 87-89

Practise the full BTSC 3 August 2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.