Developmental phases of the short-interaction, short-term nurse-patient relationship.

The increasing interest in the concept and practices of short-term and the rapid development of short-term psychiatric services in community general hospitals have resulted in a decrease in length of hospital stay for psychiatric patients. This would seem to create a dilemma for those psychiatric nurses who use Nursing; theory as a basis for the care they give. The development of nurse-patient relationship has been considered to be one of the most important means by which a psychiatric nurse can help a patient. Although Nursing; textbooks describe such a therapeutic relationship as a process consisting of several developmental phases, the standard time of interaction, length of the relationship, or time required for each phase is not clearly indicated. There seems to be an inference that the process refer to long term, intensive relationships. The purpose of this study was to determine if phases described in theory would occur in the development of the nurse-patient relationship limited to 15 minute daily interactions over a period of 10 days. Five female patients (three depressed reaction and two paranoid schizophrenic) were seen by the investigator for 15 minutes each day for 10 days during their hospitalization. Immediately following each interaction, the investigator wrote a process recording of the conversation. Each process recording was divided into verbal units defined as a complete sentence or portion of sentence that expressed a complete thought. The four phases of orientation, testing, and establishment of trust, working through, and termination were used as categories for interaction analysis. In order to gain a valid statement of the content of each phase, 8 psychiatric nurse specialists were asked to place statements describing portions of nurse-patient interaction into one of the four phases. The resulting pattern of behavioral statements served as a definition of each phase and as a model for classification of data. The investigator and a psychiatric nurse specialist performed an interaction analysis of each of the 50 process recordings by placing each verbal unit into the appropriate phase. A percentage profile of verbal units in each phase was determined for each 15-minute interaction of the five nurse-patient relationships. A Pearson product-moment correlation was calculated between the investigator and specialists’ scores to determine rater reliability for each relationship. Correlations for all 5 patients were low; four of the five were significant at the P .05 level. A coefficient of concordance was performed to determine the pattern of similarity of phases between patients. Only Phase I was significantly similar. The findings of the investigator’s interaction analysis were summarized by presenting a mean percentage profile of the phase development of the nurse-depressed patient relationship and the nurse-paranoid relationship. The lack of statistical significance failed to support the expectation that phases described by Nursing; theorists for intensive relationship also occur in short-interaction, short-term nurse-patient relationships. Various possible reason for low rater reliability and lack of similarity in pattern were discussed.