In an in-patient psychiatric unit, the nurse helps the patient practice various techniques of assertive communication and gives positive feedback for attempting to improve passive-aggressive interactions. This interaction would occur in which phase of the nurse-patient relationship?

1. A

   Pre-interaction phase

2. B

   Working phase

3. C

   Termination phase

4. D

   Introductory phase

Appeared in: UP NHM CHO 7 Sept 2022(shift-1st)

Explanation

• The working phase is the core of the therapeutic process where the nurse and patient collaborate to solve problems and achieve goals.
• Key activities in this phase include promoting patient insight, facilitating behavioral change, and practicing new, constructive coping mechanisms.
• The scenario describes the nurse actively helping the patient practice assertive communication and providing positive feedback, which are classic examples of interventions in the working phase.

Why Other Options Were Wrong

• Option A: The pre-interaction phase occurs before the nurse has any contact with the patient. It involves preparation, such as reviewing the patient's history and self-assessment by the nurse.
• Option C: The termination phase is the conclusion of the relationship. It focuses on summarizing progress, evaluating outcomes, and preparing the patient for discharge or transition.
• Option D: The introductory, or orientation, phase is the beginning of the relationship. The focus is on establishing trust, defining the problem, and setting goals, not on the intensive work of practicing new behaviors.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Phases of the therapeutic nurse-patient relationship to guide bedside assessment, documentation, and the next nursing action.
• Understanding the phases of the nurse-patient relationship is fundamental in psychiatric nursing. It allows the nurse to structure interactions purposefully and use phase-appropriate interventions to build trust and facilitate patient growth.
• A common challenge is when a patient regresses or shows resistance during the working phase. A skilled nurse recognizes this as part of the process and uses therapeutic techniques to explore the resistance rather than becoming discouraged.
• What if the patient was expressing anxiety about being discharged and leaving the unit? This would signal a shift into the Termination phase, and the nurse's focus would change from practicing new skills to helping the patient process feelings about ending the therapeutic relationship and applying their new skills in the outside world.

How to Approach the Question

• First, identify the core action described in the question stem. Here, the key action is the nurse helping the patient 'practice' new communication techniques and giving 'positive feedback'.
• Recognize that this action is not about preparation, introduction, or conclusion, but about active, ongoing therapeutic work.
• Recall the four phases of the nurse-patient relationship: Pre-interaction, Introductory/Orientation, Working, and Termination.
• Match the identified action (practicing skills, facilitating behavioral change) to the definition of the Working Phase.
• Systematically rule out the other phases by comparing their primary goals to the action in the scenario. Pre-interaction involves no patient contact. Introductory phase is for establishing goals. Termination phase is for ending the relationship.

Concept Tested & Keywords

• Concept Tested: Phases of the therapeutic nurse-patient relationship
• Stem keywords: in-patient psychiatric unit, assertive communication, positive feedback, passive-aggressive interactions, nurse-patient relationship
• Lead-in keywords: which phase
• Negative lead-in flag: false

Question ID

QhRSO77K-vaetUdUmzb2Jn

Copy ID

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 110-112

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

E6 Nursing Fundamentals Taylor p. 87-89