# 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. Before meeting her, the nurse writes down personal feelings about caring for people with depression, because the nurse's own father had the same illness. What is the purpose of this activity?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629997  
> 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.

Before meeting her, the nurse writes down personal feelings about caring for people with depression, because the nurse's own father had the same illness. What is the purpose of this activity?

## 보기

1. To recognize reactions that could shape the nurse's care **✔ 정답**
2. To collect baseline data for the client's nursing diagnosis
3. To prepare the goals that will be written into the contract
4. To decide whether the nurse should ask for another assignment

**정답: 1**

## 해설

Self-exploration of feelings, fears, and biases is the main task of the pre-interaction phase. Self-awareness lets the nurse recognize personal reactions, such as those rooted in a family member's illness, and control their effect on the client, which helps prevent countertransference.

## 심화 해설

The task of the pre-interaction phase
Peplau's and later models of the nurse-client relationship describe phases: pre-interaction, orientation, working, and termination. The pre-interaction phase happens before the nurse meets the client, and its main task is self-exploration of the nurse's own feelings, fears, and biases. Writing down personal feelings about caring for people with depression helps the nurse recognize reactions that could shape care, especially because the nurse's own father had the same illness.

Self-awareness and countertransference
Countertransference occurs when a nurse's feelings toward a client are shaped by the nurse's own past relationships rather than by the client. A nurse whose parent had depression may, without realizing it, feel overly protective, impatient, hopeless, or anxious with a depressed client. Naming these reactions in advance does not remove them, but it allows the nurse to notice them during sessions, discuss them in clinical supervision, and keep them from guiding decisions. Self-awareness is therefore the foundation of therapeutic use of self.

| Phase | Main tasks |
| --- | --- |
| Pre-interaction | Self-exploration of feelings and biases; gather information about the client |
| Orientation | Build trust, set the contract, identify problems |
| Working | Explore stressors, promote insight, practice new behaviors, handle resistance |
| Termination | Review progress, discuss feelings about ending, link to aftercare |

Why the other purposes are wrong
Baseline data for the client's nursing diagnosis come from the client, the chart, and the team, not from the nurse's own feelings. Contract goals are set together with the client during the orientation phase. Personal history is not in itself a reason to refuse an assignment; with self-awareness and supervision, a nurse who has lived experience of a family member's illness can work safely and may even bring added empathy.

Watch out! Information gathering from the chart and team also happens in the pre-interaction phase, but the activity in this stem is about the nurse's own feelings. Match the answer to what the nurse is actually doing.

Exam takeaway
Key point! The pre-interaction phase begins with the nurse examining personal feelings, fears, and biases so they do not distort care. This self-awareness helps prevent countertransference throughout the relationship.

## 임상 시나리오

Pre-Interaction PhaseSelf-awareness before meeting the client
The main task of the pre-interaction phase is self-exploration of the nurse's own feelings, fears, and biases.

A nurse whose parent had depression may react to a depressed client in ways shaped by that history. Recognizing this in advance helps prevent countertransference.

Supervision supports the nurse in managing these reactions. Baseline data come from the client and chart, and goals are set with the client in orientation.

CautionPersonal history is not a reason to refuse a client; awareness and supervision allow safe practice.

## 핵심 개념

- **Pre-interaction phase** — The phase before meeting the client, when the nurse explores personal feelings and reviews available information.
- **Countertransference** — A nurse's emotional reaction to a client shaped by the nurse's own past relationships.
- **Therapeutic use of self** — The nurse's deliberate use of personality and communication to help the client.
- **Clinical supervision** — Regular guided reflection with an experienced clinician to examine reactions and improve care.

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