FACTORS INFLUENCING MOVEMENT OF CHRONIC PSYCHIATRIC-PATIENTS FROM THEORIENTATION TO THE WORKING PHASE OF THE NURSE-CLIENT RELATIONSHIP ON AN INPATIENT UNIT

PROBLEM. TO identify factors influencing movement of nurse-patient dya ds from Peplau's orientation phase to the working phase of the nurse-c lient relationship in a tertiary care psychiatric setting. METHODS. Te n nurse-client dyads were interviewed after the initial nurse-client a ssignment until a consensus was reached between client, nurse, and inv estigator/CNS that the relationship was in the working phase. FINDINGS . Factors causing the relationship to progress, from the clients' pers pective, were the perceived attitude of the nurse, the nature of the p lanned therapeutic sessions, and what happened between therapeutic ses sions. Factors hindering rite development of the relationship included a nurse's or client's unavailability, a sense of distance/inequity, d ifferences in realities/values, and mutual withdrawal. The relationshi p was perceived as supportive and ''powerful'' when it progressed to t he working phase, but as very negative and like ''limbo'' if instead i t moved to a phase of mutual withdrawal. CONCLUSIONS. Nurses can help clients move from the orientation phase to the working phase by remain ing available, consistent, and acting in a way that promotes trust. Wh en the relationship does not progress to the working phase within 6 mo nths, a therapeutic transfer should be considered.