# Situation: A nurse on the psychiatric ward of a general hospital is assigned to a 34-year-old woman admitted for major depressive disorder. The nurse will hold one-to-one sessions with her three times a week during her expected 4-week stay. In which phase of the nurse–client relationship should the nurse tell her the date on which their sessions will end?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629996  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse on the psychiatric ward of a general hospital is assigned to a 34-year-old woman admitted for major depressive disorder. The nurse will hold one-to-one sessions with her three times a week during her expected 4-week stay.

In which phase of the nurse–client relationship should the nurse tell her the date on which their sessions will end?

## 보기

1. Pre-interaction phase
2. Orientation phase **✔ 정답**
3. Working phase
4. Termination phase

**정답: 2**

## 해설

The end date is set in the orientation phase as part of the contract, together with the time, place, frequency, roles, goals, and limits of confidentiality. Knowing from the start when the relationship will end prevents unrealistic expectations and gives the client time to prepare for separation.

## 심화 해설

Therapeutic relationship phase and setting the end date

The correct phase is the orientation phase. In Peplau’s Interpersonal Relations Theory, the nurse–client relationship moves through predictable phases, and each phase has distinct tasks. The orientation phase is when the nurse and client first meet, establish trust, clarify roles, and negotiate the practical structure of the relationship [1]. Setting the end date belongs to this early contracting work because it defines the relationship as time-limited from the very beginning.

During the orientation phase, the nurse and client agree on the contract: when and where sessions occur, how often they meet, what each person’s role is, what goals they will pursue, and the limits of confidentiality. The termination date is part of that same contract. Telling the client the end date during orientation prevents unrealistic expectations and gives her time to prepare emotionally for separation. This is especially important in major depressive disorder, where feelings of abandonment or loss can intensify if the ending feels sudden or unannounced.

The other phases serve different purposes. In the pre-interaction phase, the nurse prepares before meeting the client—reviewing the chart, examining personal feelings and assumptions, and planning the first encounter. No contract is made yet because the client is not present. In the working phase, the client uses the relationship to explore feelings, practice new coping skills, and work toward the identified goals; the structure of the relationship has already been established. The termination phase is when the ending is processed and evaluated—but the date itself was set much earlier.

| Phase | Key task | Is the end date set here? |
| --- | --- | --- |
| Pre-interaction | Nurse self-preparation, chart review, anticipating reactions | No |
| Orientation | Building trust, clarifying roles, negotiating the contract including time, place, frequency, goals, confidentiality limits, and termination date | Yes |
| Working | Exploring problems, practicing new skills, achieving goals | No |
| Termination | Reviewing progress, processing feelings about ending, evaluating the relationship | No |

Watch out! The termination phase is about *processing* the ending, not *deciding* when it will happen. The date is announced in the orientation phase so that termination work can be planned and anticipated throughout the relationship.

Key point! A time-limited contract established in the orientation phase supports therapeutic boundaries and reduces the risk of dependency or unrealistic expectations. Peplau’s framework emphasizes that relationship progress mirrors patient progress, and a clear beginning, middle, and end provides the structure that makes that progress possible [1].References (research sources)

- [1]A literature review of the progress of the psychiatric nurse-patient relationship as described by Peplau.Research articleStockmann C (2005) · DOI: 10.1080/01612840500248197

## 임상 시나리오

Setting the End Date in the Orientation PhaseEstablishing a time-limited therapeutic contract from the first meeting
In Peplau's Interpersonal Relations Theory, the orientation phase is when the nurse and client first meet, build trust, and negotiate the contract. This contract includes the time, place, frequency, roles, goals, confidentiality limits, and termination date. Announcing the end date early defines the relationship as time-limited from the start, preventing unrealistic expectations and allowing the client to prepare emotionally for separation.

For a client with major depressive disorder, knowing the end date from the beginning is especially important because feelings of abandonment or loss can intensify if termination feels sudden or unannounced. The expected 4-week stay should be stated clearly during the first one-to-one session.

CautionDo not delay the end date discussion until the working or termination phase. The pre-interaction phase occurs before meeting the client, so no contract can be made. Waiting until termination risks worsening depressive symptoms related to loss.

## 핵심 개념

- **Orientation phase** — First phase of the nurse-client relationship where trust is established and the contract including time, place, goals, and end date is negotiated.
- **Peplau's Interpersonal Relations Theory** — Framework describing four sequential phases of the therapeutic nurse-client relationship: pre-interaction, orientation, working, and termination.
- **Nurse-client contract** — Agreement made during orientation covering session logistics, roles, goals, confidentiality limits, and termination date.
- **Termination phase** — Final phase where the relationship concludes and the client's progress and feelings about separation are processed.

## 같은 주제 문제

- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629986)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629987)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629988)
- [Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital aft…](https://mymerci.kr/pages/nclex_q.php?qn_id=629989)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629990)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629991)
- [Situation: A 52-year-old man is seen at the outpatient mental health clinic of a provincia…](https://mymerci.kr/pages/nclex_q.php?qn_id=629992)
- [Situation: A 40-year-old woman is admitted to the psychiatric ward with major depressive d…](https://mymerci.kr/pages/nclex_q.php?qn_id=629993)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._