Factors Influencing Movement of Chronic Psychiatric Patients From the Orientation to the Working Phase of the Nurse-Client Relationship on an Inpatient Unit

Abstract

Nurses can help clients move from the orientation phase to the working phase by remaining available, consistent, and acting in a way that promotes trust. When the relationship does not progress to the working phase within 6 months, a therapeutic transfer should be considered.

A Literature Review of the Progress of the Psychiatric Nurse-Patient Relationship as Described by Peplau

“…Clients described closeness, genuine liking, and trust, with the focus remaining on client needs as typical of the working phase. Forchuk, Westwell, et al (2000) described the perspectives of the nurses on the progress of the PNPR from the data generated from interviews with nurse-patient dyads (Forchuk, Westwell, et al, 1998). Nurses identified the factors that supported and hindered the development of the PNPR established with severely, persistently mentally ill clients.…”

“…Situations where nurses knew the clients for an extended amount of time prior to working with them or where clients had multiple readmissions resulted in negative perceptions of the relationship. Forchuk, Westwell, et al (1998) examined factors influencing the movement of the PNPR from the orientation phase to the working phase, based on the assumption that nurse-client dyads cannot begin working on patient problems until the orientation phase is completed. Ten newly formed nurse-client dyads were interviewed regarding the progress of their relationships.…”

Understand me; believe in me; accept me as I am: perceptions of psychiatry of later life service

“…Mastering interpersonal engagement is the starting point of any therapy (Butler et al 2011). Forchuk et al (1998 agree with this study's findings stating that this rapport is dependent on the attitude of staff with friendliness, interest, caring, understanding, having a passion for work and treating the SU as a human being as central requirements.…”

A qualitative evaluation of patient’s perceptions of therapeutic alliance on mental health acute inpatient wards

“…Studies carried out on the nature of the Therapeutic Alliance emphasize this general assessment: The Therapeutic Alliance is a phenomenon that we absolutely have to favour if we want to obtain a psychotherapeutic effect and an observance of a medical treatment [8].…”