In working with the patient, when is the best time to prepare the patient for the termination phase?

DSSSB Public Health Nurse - 2015

Nursing Foundation

Medium

Appeared in: DSSSB Public Health Nurse - 2015

Explanation

The orientation phase is the initial stage of the nurse-patient relationship where trust is established and the parameters of the relationship are defined.
A key task during the orientation phase is to form a contract with the patient, which includes clarifying roles and the expected duration of the therapeutic relationship.
Informing the patient about when the relationship will end during this early phase helps manage expectations, builds trust, and minimizes potential feelings of anxiety or abandonment later.
This proactive approach sets a professional tone and ensures the relationship remains goal-oriented and therapeutic from the beginning.

Option A: The pre-interaction phase occurs before the nurse meets the patient. It involves the nurse's preparation, such as reviewing the patient's history. There is no patient contact, so it's impossible to prepare the patient for anything.
Option C: The working phase is when the nurse and patient are actively collaborating to solve problems and achieve goals. While the eventual termination is understood, the primary focus is on the therapeutic work, not on preparing for the end.
Option D: The termination phase is the actual conclusion of the relationship. Preparing the patient during this phase is too late and can lead to an abrupt and difficult ending. The goal of this phase is to summarize progress and say goodbye, which relies on prior preparation.

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 preparing a patient for termination is a critical nursing skill that upholds professional boundaries and prevents patient dependency.
It helps mitigate feelings of loss, anger, or abandonment that patients, especially those with mental health challenges, may experience when a supportive relationship ends.
What if? If a nurse fails to discuss termination during the orientation phase, the patient might feel betrayed or abandoned when the nurse's rotation ends or upon discharge, potentially undermining the therapeutic progress made.

How to Approach the Question

First, identify the core concept of the question, which is the timing of a specific action ('prepare for termination') within a process (the nurse-patient relationship).
Recall the four phases of the therapeutic nurse-patient relationship as defined by Hildegard Peplau: Pre-interaction, Orientation, Working, and Termination.
Analyze the purpose of each phase. The 'Orientation' phase is about setting the stage, defining rules, and establishing a contract for the relationship.
Logically deduce that any 'preparation' for the end of a contract or relationship should happen at the beginning, when the terms are set.
Eliminate the other options: 'Pre-interaction' is too early (no patient contact), 'Working' is focused on the tasks, and 'Termination' is too late (it's the event itself, not the preparation for it).

Concept Tested & Keywords

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

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 112-114