RECORDS MANAGEMENT  To protect the interests of staff, students

Records management (RM) is the supervision and other stakeholders

and administration of digital or paper records,  Help to address complaints or legal
regardless of format. processes.
 To support patient choice and control over
It is a systematic and effective control of treatment and services
records (both paper and electronic). It aims to  To support day to day business of the
ensure that records are accurate and reliable, health care delivery
 To support evidenced based practice
can be retrieved speedily and efficiently, and
 To assist clinical and other types of audits
efficiently, and are kept for no longer than  To support sound administrative and
necessary. It is crucial to all organizations. managerial decision making.
Unless records are managed efficiently it is  To support improvement in clinical
possible to conduct business, to account for effectiveness through research
what happened in the past, or to make
decisions are kept for no longer than necessary.
BENEFITS OF RECORD MANAGEMENT

Records management activities include the  Saves time by ensuring that records can
creation, receipt, maintenance, use and be found easily and quickly
disposal of records. Documentation may exist in  Save space by preventing records from
contracts, memos, paper files, electronic files, being kept longer than Necessary
reports, emails, videos, instant message logs or
 Saves money by reducing storage costs
database records. Paper records may be stored
and maintenance costs
in physical boxes onpremises or at a storage
facility. Digital records may be stored on storage  Improves efficiently by ensuring records
are readily accessible legally
media in-house or in the cloud.
 Improves compliance by keeping
The goal of records management is to help an records in line with legal and regularly
organization keep the necessary documentation requirements
accessible for both business operations and
 Keeps records under control by
compliance audits.
preserving data and preventing
IMPORTANCE OF RECORD MANAGEMENT accumulation control of epheral material
 Improves the quality of information,
 To provide evidence of actions and
providing staff with access to accurate
decisions
 To support accountability and transparency and reliable quality records security
 To comply with legal and regulatory
 Increases the security of confidential
obligations, including employment, contract
records continuity
and financial law as well as the data
protection act and freedom of information  Support business continuity and risk
act management
  Records are managed efficiently and  Meeting minutes
can be easily assessed and used  Payroll folders
 Records are stored as cost effectively as  Contracts-purchase lease rental, and etc.
possible and when no longer required
they are disposed of in a timely and Records in the Nursing Office and Unit
efficient manner.
 Administrative records: organogram, job
 Complies with requirements concerning description, procedure manual
records and records management  Personnel records: personal files,
records
practices to ensure compliance with
 Patient records send to medical center
institution
chief/medical director
 Records of longer term value are
 Leave record, duty roster, minutes of the
identified and protected for historical and
meeting, budget etc.
other research
 Miscellaneous: circular log book,
formats, etc.
Record
It is a permanent written communication that Principles of Record Writing

documents information relevant to a client’s

 Nurses should develop their own
health care management. E.g. chart is a
method of expression and form in record
continuing account of client health care status
writing
and need.
 Records should be written with clearly
and appropriately
A record is a clinical, scientific, administrative
and legal document relating to the nursing care  Records should contain facts based on
observation conversation and action
given to the individual family and community.
 Select relevant facts and the recording
should be neat, complete and uniform
Sample of records
 Records should be written immediately
 Administrative records of
Grants/Contracts after an interview

 Bid documents  Records are confidential documents.

 Blueprint of facilities
SAFEKEEPING AND RELEASE OF
 Consent forms-adult-minor RECORDS
 Endowment Fund Records
 Equipment inventory reports 1. Sentinel events

 General ledgers 2. Anecdotal

 3. Incident report Individual Staff Record
4. Kardex
A separate set of record is needed for
5. Patients chart/records
staff, giving details of their sickness and
6. 201 file absences.

Nurses responsibility for record keeping and Ward Records

recording

Reducting or increase in beds

 Keep under safe custody of nurse
Change in medical staff and non-nursing
 No individual sheet should be separated
personnel for the ward The introduction
 Not accessible to patient and visitors
and patient of support
 Strangers is not permitted to read
records
Characteristic of a Good Record and
 Records are not handed over to the Reporting
legal advisors without written permission
of the administration Accuracy

 Handed carefully, not destroyed Consciousness

 Identified with bio-data of the patients Thoroughness
such as name, age, admission number, Up to date
diagnosis, etc.
Organization
 Never sent outside the hospital without
the written administrative permission Confidentiality

Objectivity
Nursing Administrator’s Responsibility
Purposes of Record
 Protection from loss
 Safeguarding its concerns • Supply data that are essential for
 Completeness programme planning and evaluation

 Responsibility for nurse notes • Provide the practitioner with data

required for the application of
 Admission record
professional services for the
 Scientific value of the nurse notes
improvement of family health
 Record of order carried out
• Used as tools of communication
between health workers the family and
other development personnel
 • Shows the health problem in the family Used for teaching and research
and other factors that affect health
• Indicates plan for future For the Nurses
• Provides baseline data to estimate the
long term changes related to services Document nursing service rendered

Administrative Purpose of clinical records Planning and evaluation of service for future
improvement
• Legal documents: poisoning, assault,
rape, leaving against medical advice Guide for professional growth
(LAMA/HAMA/DAMA)
Communication tool between nurse and other
• Research or statistics rates
staff involved in the care Indicate plan for
• Audit and nursing audit future
• Quality of care
For Authorities
• Continuity of care
• Informative purposes: MEN census
 Statistical Information
• Teaching purposes of students
 Administrative control
• Diagnostic purposes: test reports
 Future reference
Importance of Records in Hospital (For  Evaluation of care in terms of quality,
individual and family) quantity and adequacy
 Help supervisor to evaluate service
 Serve the history of the client
 Guide staff and students
 Assist in the continuity of cares
 Legal evidence of service rendered by
 Evidence to support if legal issues arise each employee
 Assess health needs: research and  Provide justification of expenditure of
teaching funds

For the Doctor INTRA-DISCIPLINARY,

INTERDISCIPLINARY AND
Serve the guide for diagnosis, treatment, follow MULTIDISCIPLINARY AND WORK
up and evaluation COLLABORATION
COLLABORATION
Indicate progress and continuity of care
Current educational and clinical environments
can be less than supportive of interpersonal
Self-evaluation of medical practice
learning interaction. Urges the nurse educator
community to work with peers in other
Protect doctor in legal issues profession to provide students with learning
opportunities that acknowledge a profoundly
changed health care environment. Providing
educational experiences that prepare graduates
for todays’ practice is no loner an option; it is
imperative to align health professional
education with the societal needs, Marquis &
Huston, (2012).

The nursing profession is faced with

increasingly complex health care issues driven
by technological and medical advancements,
an ageing population, increased numbers of
people living with chronic disease, and
increased costs of health care services

• Collaborative partnerships between

educational institutions and service
agencies have been viewed as one MEANING
way to provide research which ensures
an evolving health-care system with • The roots of the word collaboration,
comprehensive and coordinated namely co-, and elaborate, combine in
services that are evidence-based, cost Latin to mean “work to together.” That
effective and improve health-care means the interaction among two or
outcomes. more individuals, which can
encompass a variety of actions such as
• Considerable progress has been made communication.
in nursing over the past several Information sharing, coordination, cooperation,
decades, especially in the area of problem solving, and negotiation.
education. • Teamwork and collaboration are often
used synonymously.
• The collaborative process involves a
• Countries have either developed new,
synthesis of different perspective to
strengthened and re-oriented the
better understand complex problems.
existing nursing educational programs
• An effective collaboration is
in order to ensure that the graduates
characterized by building and
have the essential competence to
sustaining “win-win- win”
make effective contributions in
relationship.
improving people’s health and quality of
life • Is a process by which members of
various disciplines (or agencies) share
their expertise to accomplishing a
common goal?
• Accomplishing this goal requires these
individuals to understand and
appreciate what they are contribute to
the whole”
• “Collaboration is the most formal inter
organizational relationship involving
 shared authority and responsibility for Is the term used to indicate the
planning, implementation, and combining of two or more
evaluation of a joint effort, Marquis and disciplined, professions,
Huston, (2017). department, integrated for one
• Collaboration defined as a joint plan formulation usually in
communication and decision-making regard to practice, research
process with the goal of satisfying the education, and/or theory?
health care needs of a target
population. NNCCS, (2012).
Multidisciplinary
• Mattessich, Murray and Monsey
(2001), define collaboration as’… a Refers to independent work and
mutually beneficial and well- defined decision making, such as when
relationship entered into by two or more disciplines work side-by-side on
organizations to achieve common goal. a problem.

EFFECTS OF COLLABORATION Tran disciplinary

Efforts involve multiple

disciplines sharing together
their knowledge and skills
across traditional disciplinary
boundaries in accomplishing
tasks or goals.

Inter professional
collaboration
Interactions of two or more
disciplines involving
 Improved patient outcomes professionals who work
 Reduced length of stay together, with intention, mutual
 Cost savings respect, and commitments for
 Increased nursing job satisfaction and the sake of a more adequate
retention response to a human problem.
 Improved teamwork

NEED FOR
TYPE OF COLLABORATION
COLLABORATION
Interdisciplinary
 Increasing gap between nursing
education and nursing service.
  Graduate nurses often lack practical especially those
skills despite their significant that will impact the
knowledge of nursing process and student experience
theory. directly.
 Clearly, a partnership between nursing • Help students feel
educators and hospital nursing a sense of
personnel is essential to meet the belonging in the
challenge agency
• Provide
opportunities for
MODELS OF COLLABORATION the student to
participate in
 Preceptor-ship important agency
model functions such as
 Mentorship model meetings,
 Lecturer outreach events,
practitioner model etc. as
 Research joint appropriate.
appointment • Be aware of the
 Clinical school of student’s learning
nursing model goals so that can
 Collaborative be help structure
clinical education experiences that
model will help the
student meet
goals.
PRECEPTORSHIP MODEL • Give honest,
constructive
feedback to the
 A preceptor is teacher or instructor with student and faculty
special training and he care provide supervisor as
practical training to an intern or staff. needed.
 The best preceptor like to teach and • Meet with student
they will volunteer for the role rather at frequent,
than wait to be assign regular intervals to
provide feedback,
evaluate progress
and resolve
Responsibilities of the Preceptee’s
problems
• Remember what
• Provide an
may see basic or
orientation for the
easy for the
students and
preceptor may not
• Review agency
be basic or simply
guideline with
to the student
students,
 MENTORSHIP MODEL • Guide
• Advisor
• Role model
Mentoring is A developmental • Chosen
• May have no formal preparation
relationship in which a more
• Share Life, education, work
experienced person helps a less experience
• Type of relationship” close,
experience person… personal friendship
• Not an evaluator
The Value of Mentoring: Preceptors
Mentoring provides

• Willing to teach and learn skills

 Retention by means of
• Expertise
personal relationship
 Staff development and
• Competent practitioner
career guidance • Teaching and support
 Job satisfaction, and a • Orientation and Socialization
healthy workplace • Role Model
environment • Selected
• Assigned to learner
Roles of Mentors
• Prepared for role
• Competent practitioner
• Support needed from peers,
 Teacher (educational
educators, manager
expertise)
• Functional not intimate
 Guider
relationship
 Counselor (practical
• May evaluate
expertise)
 Advisor
MENTOR VS PRECEPTOR
LEARNER OUTCOMES
MENTORS VS PRECEPTORS Mentors
Mentors

 Self-actualization
• Older than Learner  Guide to established own place in the
• Possesses wisdom and profession
experience  Enhanced problem-solving
• Career networking  Personal satisfaction in sharing
• Facilitator knowledge
 Preceptors a basis for improving critical thinking
and clinical decision-making of nurses
• In this arrangement the researcher is a
 Bridge theory to practice gap. faculty member at the educational
 Achievement of planned learning institution with credibility in conducting
research and with an interest in
outcomes
developing a research programs in the
 Skills and knowledge  Anxiety clinical setting
reduction
• The Director of Nursing Research,
provides education regarding research
and assists with the conduct odd
LECTURER PRACTITIONER Research in the practice setting.
MODEL
• She/He also lecturer or supervisor in
the educational institution.
• A formal agreement exists within the
Each clinical placement gave to have two organizations regarding specific
named lecturer / practitioner or clinical responsibilities and the percentage of
educator who will assist in the
time allocated between each salary and
organization, facilitation and
Benefits are shared between the two
supervision of the clinical learning
organizations
experience throughout the entire
programs. CLINICAL SCHOOL OF NURSING
Role of Lecturer Practitioner MODEL

• Promote active discussion within the

 The concept of a Clinical School of
Nursing is one that Encompasses the
clinical setting to encourage
highest level of academic and clinical
understanding
nursing research and education.
• Work with clinical staff to identify
 The development of the Clinical School
alternative means to gain relevant
offers benefits to both hospital and
experience
university.
• Play an active role in overall
 It brings academic staff to the hospital,
assessment to help student achieves
with opportunities for exchange of
the required learning outcome
ideas with clinical nurses with
Research Joint Appointments increased opportunities for clinical
nursing research.
 It has a fundamental importance and
• Is a formalized agreement between two close link between the theory and
practice of nursing at all levels
institutions where an individual holds a
position in each institution and carries COLLABORATIVE CLINICAL
out specific and defined EDUCATION MODEL
responsibilities”?
• The goal of this approach is to use the
implementation of research findings as
  In an effort to improve the quality of  Application of these models can reduce
new graduate transition, Epworth the perceived gap between education
Hospital and Deakin University ran and service in nursing, also can help in
a collaborative project (2003) the development of competent and
founded by the National Safety and efficient nurses for the betterment of
Quality Council to improve the nursing profession.
support base for new graduates
while managing the quality of
patient are delivery. Students Coached by Clinicians -
 The collaborative clinical Education Nursing Education Supported by
Epworth Deakin (CCED) model Clinical Facilitator - Clinical
developed to facilitate Facilitators are supported by Hospital -
 Clinical learning University to Students Coached by
 Promote clinical scholarship and Clinicians
 Build nurse workforce capability

Example

 Undergraduate nursing students

attending lectures at Deakin University
in the traditional manner but completing
all tutorials, clinical learning,
laboratories and clinical placements at
Epworth Hospital throughput their three
year course.
 Tutorials, laboratories and clinical
placements are conducted by Epworth
clinicians who are prepared and
supported by Deakin School of Nursing
Faculty.
 These clinicians also support the
student-preceptor relationship in the
clinical learning component of the
curriculum.
 All the models pursue collaboration as
a means of developing trust,
NNCCS, 2014
recognizing the equal value of
stakeholders and bringing mutual
benefit to both partners on order to
promote high quality research,
continued professional education and
quality health care. In a hospital setting, multidisciplinary teams,
involves or combines several academic or
professional disciplines, either formal or
informal groups meet to accomplish goals and
objectives, members practice independently of In a community setting, the Intra-agency, Inter-
one another, each of the member is being agency, multidisciplinary and sectoral
guided by their own professional standards collaboration are important in the effective and
however leadership always determined by efficient delivery of health services to the
professional hierarchy. individuals, families, population groups and the
community. The nurse is responsible in
maintaining harmonious relationship within the
As illustrated above the interdisciplinary and
health unit (intra-agency) and coordinating
multidisciplinary team collaboration involves
activities of the members of the health team to
the contribution from different departments of
ensure achievement of group goals.
their services and shared their own
professional expertise to achieve optimum
health of the patient. The vital role of the
nurse it to coordinate, communicate and
documents services provided by the team as DEVELOPMENT OF TEAM WORK AND
shown in the illustration. COLLABORATION

Stages of Team Development

According to Tuckman there 4 stages of Team

Development. These stages are important
and inevitable for a team to grow, face
challenges and difficulties effectively and
deliver positive results.

Stage 1 Forming, the leader may seek control

over the team and exemplify styles such as
“tyrant”, “superwoman”, “party host”, or
“reluctant candidate”, Members are also
characterized by dependency-seeking
behaviors and will most likely rely on the group
leader. They may also take on the roles of
“scapegoat” and “helper’.

Stage 2 Storming, Leader tries to persuade

the team and may use “salesman” ad “nice
guy” styles often struggling to be a socio—
emotional leader. Team members may
demonstrate resistance. Despite persistence
of scapegoating among team members, new
roles that help reduce tension may emerge.
Stage 3 Norming, coalitions of member’s  Encouraging
exercise leadership based on previously  Following
demonstrated competence. Members have  Climatizing
evolved into colleagues who were able to
defer to each other’s relevant experience. 3.. Individual roles in which a team member
attempts to satisfy individual rather than team
Stage 4 Performing, Authority is exercise by goals. A team is most productive when all
coalition of colleagues. Team members three (3) sets are managed simultaneous.
exemplify interdependence. Individual roles are:

 Blocking/Aggressing
 Out of field
Tools for Facilitating Health Care Team Work  Digressing
 Recognition seeking (Sullivan and
Decker, 2009
Working together does not necessarily
produce effective teamwork.
NURSE’S ROLE IN ESTABLISHING
Here is a simple outline that will guide in the COLLABORATIVE RELATIONSHIP IN THE
understanding of the process of developing DELIVERY OF HEALTH CARE PROGRAMS
health care teamwork. Analysis of informal AND SERVICES
roles provides another useful tool for
understanding the team process. A. Maintains good interpersonal relationships
intra-agency and inter-agency.
There are three (3) broad sets of informal B. Respects the role of other team members.
roles: C. Acts as a liaison/advocate of the client
during decision making by the
interprofessional team. Interpersonal
1.Task roles that are necessary for Relationship Defined:
accomplishing the team’s task. These roles The term Interpersonal Relationships refers
are as follows: to reciprocal social and emotional
interactions between two or more persons in
 Initiating/energizing an environment and who share common
interests and goals.
 Information/opinion giving
 Information/opinion seeking
 Reality testing/clarifying Importance of Interpersonal Relationship for
 Coordinating Nurses:
 Orienting 1. Helps build positive functional
 Procedural Technician multidisciplinary team.
2. Improves intra and/or inter-team
2.Maintenance roles which help the team communication, coordination, and
function as a team. Maintenance roles are: cooperation
3. Builds mutual understanding and
 Harmonizing cooperation
 Gatekeeping 4. Facilitates better understanding of oneself
5. Improves decision making and problem- establishment of common ground, and
solving may be centered around something(s)
shared in common
• In nursing care can be defined, based
To maintain good interpersonal relationship in on a theory 1, as the interaction
working with a team to achieve its goal of between two or more people who
providing safe and quality patient/ client care, communicate, transfer values and
it is also important for the nurse to energy from their roles in society
appropriately respond to conflict situations. In • Such interaction is continuous
the process, conflict may occur within the
individual (intrapersonal), between two or
more individuals (interpersonal), and between Dynamics of Interpersonal Relationship
one or more groups (intragroup). Categories of • Dyad
Conflict Conflict is a disagreement among • Group
people involved that results from differences in • Triad
ideas, values, or feelings, differences in
economic and professional values, poorly Dynamics of Interpersonal Relationship I.
defined role expectations and there is DYAD
competition among the professional  A Dyad consists of two interacting
themselves, Filley (1975). people
 It is the simplest of the three
interpersonal dynamics
NURSE INTERPERSONAL RELATIONSHIP  One Person relays a message and
the other listen
 Doctor - Nurse relationship  It is none of the most unstable
 Nurse – Patient relationship interpersonal dynamic. The
 Nurse – Nurse relationship interaction ends when one
constituent of the dyad refuses to
listen or share his or her message
• One of the most distinctive aspects of
 It is also one of the most intimate
human being is that we are social
interpersonal dynamic as the focus
beings
of listening and communication is
• Interpersonal relationships are and
centered on only one person
have been the core of our social
II. TRIAD
system since the dawn of civilization
 A triad consists or three interaction
• Nursing is a therapeutic process and
people.
demands an association between the
 The members engage in the relay
nurse and the patient
and reception of thoughts and
• Is a strong, deep or close association
ideas.
or acquaintance between two or more
 It is more stable than the dyad as
people that may range in duration from
the third members may act as a
brief to enduring
mediator when there is conflict
• Are social associations, connections, or
between the other two.
affiliation between two or more people
• They vary in differing levels of intimacy
and sharing, implying the discovery or
 III. GROUP
 A group consist of more than three I. FRIENDSHIP
members and is a collection of  Theories of friendship emphasize the
triads and dyads. concept as a freely chosen association
 It is the most stab le from of where individuals develop a common
interpersonal relationship ground of thinking and behaving when
they enter into the relationship by
including mutual love, trust respect and
PURPOSES OF INTERPERSONAL unconditional acceptance for each
RELATIONSHIP
other.
I. Interpersonal relationship for an
 Friendship is a relationship with no
individual
formalities and the individuals enjoy
 Personal growth and development each other’s presence
 Source of enjoyment
II. LOVE
 Sense of security  A in formalized intimate relationship
 Context of understanding characterized by passion, intimacy, trust
 Interpersonal needs and respect is called love.
 Establishing personal identity  Individuals in a romantic relationship are
II. Interpersonal relationship for nurses deeply attached to each other and share a
 Building a positive functional special bond
multidisciplinary team
 Improving intra-and/or III. PLATONIC
inter-team communication,  A relationship between two individuals
coordination and cooperation without feelings of sexual desire for
 Building mutual understanding each other is called a platonic
and cooperation relationship.
 Improved decision making and  In such a relationship, a man and a
problem woman are just friends and do not mix
III. Interpersonal relationship for love with friendship.
patients  Platonic relationship might end in a
 Developing a sense of security and romantic relationship with partners
comfort developing feelings of love for each
 Fostering trust and cooperation other
 Facilitating communication
 Improving socialization IV. FAMILY
 Developing and maintaining  Family communication patterns
positive feelings established roles and identify and
enable personal and social growth of
TYPES OF INTERPERSONAL individuals.
RELATIONSHIP  Family relationships can get distorted if
1. Friendship there is an unresolved conflict between
2. Love member sense other family members
3. Platonic Relationship have significant emotional difficulties
4. Professional Relationship (Work but
relationship)
 fails to bring them out unless the  Effective and flexible communication
physician or nurse enquires
PARALLEL RELATIONSHIP
V. PROFESSIONAL  Nurse / Physician
 Individual working for the same
organization are said t o share a
5 TYPES OF NURSE-PHYSICIAN
professional relationship and are called
RELATIONSHIP
colleagues.
1. Collegial relationships
 Colleagues may or may not like each
other
- Characterized by equal trust,
power, and respect are
TYPES OF RELATIONSHIP AMONG HEALTH illustrated by the following
PROFESSIONALS A. Complementary excerpt
Relationship B. Symmetrical Relationship - Nurses and physicians
C. Parallel Relationship frequently used the words
COMPLEMENTARY RELATIONSHIP peers or equals in describing
 One person is dominant and the other these relationships.
is submission
2. Collaborative relationship
 Control is not divided equally between
- Marked by mutual trust, power,
the two participants
respect, and
 Relationship are stable and predictable
3. Student – teacher relationship
also inhibit creativity and independent
thinking - Either the physician or the
nurse can be the teacher.
COMPLEMENTARY RELATIONSHIP - With residents and at times with
• Physician attending physicians who are
• Nurse dealing with comorbid disease
outside of their specialty, nurses
SYMMETRICAL RELATIONSHIP
may take a teaching / guiding
 Control is more evenly distributed
role
between the two participants
- Physicians who teach are
 Free to express their opinions
identified as having a lot of
 Power struggles occurs when
knowledge and
participants complete to acquire or
“always willing to explain or
give up control
teach
SYMMETRICAL RELATIONSHIP  Both
Dominant 4. Friendly stranger relationship
 Both Submissive - Is characterized by a formal
exchange of information and a
 Parallel Relationship PARALLEL somewhat neutral feeling tone.
RELATIONSHIP 5. Hostile / Adversarial relationship
 Control moves back and forth between
- Are marked by anger, verbal
the two participants
abuse, real or implied threats,
 Participant take turns holding and
or resignation
giving control, depending on the
circumstances, rather than competing PHASES OF INTERPERSONAL
for control RELATIONSHIP
 - Hildegard Peplau (1952) gave rather than abstractions in
the interpersonal relationship communication process
model - The nurse helps the patients
• Pre- Orientation Phase identify their problems in their
• Orientation Phase own context and use the
• Working Phase available resources to solve the
problem.
• Termination Phase
- The patient’s self-esteem will be
boosted by having feeling of
PRE- ORIENTATION PHASE B. EXPLOITATION
 Self-awareness of the nurse. Planning
- In this phase, the patient is
the progress of the interaction
made to understand the
 Client’s medical history, age, name, problems by exploring all
address
available avenues to solve the
problem.
ORIENTATION PHASE - The nurse can help the patient
 Start with an initial encounter with by extending minimal
nurse and patient
professional
 The fact formulation begins between
- The patient start exploitation all
the nurse and the patient.
the available resources in spite
 The nurse clarifies his or her roles and
of making requests to others to
responsibilities within the therapeutic
extend help
boundary to the patient.
- Finally, the patient with his or
 The Nurse identifies the patient’s
her problems
problems and
 After developing a trustworthy
relationship, the patients start clarifying TERMINATION PHASE
doubts, share perceptions and convey  This is the termination of the
their needs and expectation to the professional relationship that begins
nurse. with convalesce and rehabilitation
 There are several factors that may stage of hospitalization
affect this phase in a nurse-patient  The patient’s needs have already been
relationship met by the collaborative efforts of the
 It psychological dependence persists
between both of them, it become
WORKING PHASE
difficult to resolve the transferences or
A. IDENTIFICATION
counter transferees. A nurse must
- The nurse must approach the aware of the techniques to resolve it.
patient with empathic  The relationship must be terminated by
understanding to perceive the maintain a healthier emotional balance
patient’s current feeling. by both the parties
- The nurse must avoid
vagueness and ambiguity by
using specific terminology