What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a patient?

Orientation:

• In the beginning of the therapeutic relationship, the nurse and client are strangers to each other, yet each individual has preconceptions of what to expect – based on previous relationships, experiences, attitudes and beliefs 
• The parameters of the relationship are established (e.g., place of meeting, length, frequency, role or service offered, confidentiality, duration of relationship)
• The client and nurse begin to learn to trust and know each other as partners in the relationship
• Trust, respect, honesty and effective communication are key principles in establishing a relationship

Working Phase:

• The working or middle phase of the relationship is where nursing interventions frequently take place
• Problems and issues are identified and plans to address these are put into action. Positive changes may alternate with resistance and/or lack of change 
• It is important for the nurse to validate thoughts, feelings and behaviours 
• The nurse assists the client to explore thoughts (e.g. views of self, others, environment, and problem solving), feelings (e.g. grief, anger, mistrust, sadness), and behaviours (e.g. promiscuity, aggression, withdrawal, hyperactivity)
• The content to be explored is chosen by the client although the nurse facilitates the process
• The nurse continues his/her assessment throughout all phases of the relationship
• New problems and needs may emerge as the nurse-client relationship develops and as earlier identified issues are addressed
• The nurse advocates for the client to ensure that the client’s perspectives and priorities are reflected in the plan of care

Resolution Phase:

• The resolution or ending phase is the final stage of the nurse-client relationship
• After the client’s problems or issues are addressed, the relationship needs to be completed before it can be terminated
• The ending of the nurse-client relationship is based on mutual understanding and a celebration of goals that have been met 
• Both the nurse and the client experience growth 
• Termination may be met with ambivalence
• The nurse and the client must recognize that loss may accompany the ending of a relationship 
• Both should share feelings related to the ending of the therapeutic relationship
• Validating plans for the future may be a useful strategy 
• Increased autonomy of both the client and the nurse is observed in this phase