2.3 Communicating With Patients
Open Resources for Nursing (Open RN)
The Nurse-Client Relationship
The nurse-client relationship, also called a helping relationship, is crucial for holistic, compassionate nursing care. During a nurse-client relationship, the nurse builds rapport and establishes trust with the purpose of actively engaging the client in discussions about their feelings, emotions, care process, and decision-making. Establishing rapport with clients is of the utmost importance because it facilitates an open and honest dialogue between the client and the nurse. It facilitates therapeutic communication and engages the client in decision-making regarding their plan of care. The nurse-client relationship is a professional relationship in which the nurse practices the “art of nursing,” an abstract connection between the client’s needs, expressed behaviors, and the nurse’s perceptions and exploration of these concepts.[1]
Phases of the Nurse-Client Relationship
The nurse-client relationship evolves through several phases. A well-known nurse theorist named Hildegard Peplau described these three phases as the orientation phase, working phase, and termination phase. Some sources include an additional phase called the pre-interaction phase[2],[3]:
- Preinteraction Phase: The nurse reviews the medical record or other data in preparation for the orientation phase. The preinteraction phase can also be helpful in identifying preconceived notions about a client situation, acknowledging these feelings, and making a conscious effort to avoid biases.
- Orientation Phase: The orientation phase is a brief encounter where the nurse addresses the client by name and then introduces themself to the client, including their name and role. This introduction should include an estimated time frame for the conversation or encounter, and an explanation of what will occur. The nurse should begin to establish trust and rapport by ensuring privacy. This is especially important if sensitive topics will be discussed. While obtaining information about the client, it is important to realize the client is a unique individual with distinct needs, priorities, values and belief systems, and should be treated as such. While the nurse may not agree with the client’s values and belief systems, the nurse must respect them. Failure to establish rapport and trust during the orientation phase will block communication and make it difficult for the nurse to fully engage in therapeutic communication with the client.
- Working Phase: After the orientation phase is complete, the working phase begins. The majority of a nurse’s time is spent in the working phase with a client. Communication during the working phase should be client-focused and based on what is important to the client. Communication generally focuses on their reason for seeking medical care, but deeper concerns are discussed and explored as they come up. During the working phase, the nurse engages in therapeutic communicat