Trust A Concept Analysis In Nursing

Trust: A Concept Analysis Jaymee Penrose
Purdue University Calumet Trust: A Concept Analysis The purpose of this paper is to expand the understanding of the concept of trust and its relation to the nursing profession as it functions as a whole. Trust is fundamental in all successful relationships from business to personal. Without trust there is no confidence to believe in what someone is telling or doing for you. Thousands of articles result from googling the word trust. Countless way to build trust in the workplace, with your loved ones, and in leadership are noted. Forbes magazine acknowledges the importance of trust in leadership and builds strategies
based on trust to bring companies to higher profit levels and increased productivity (Horsager, 2012). Numerous polls on most trusted professions, place nursing in the top ten demonstrating the connection patients feel with nurses and their trust in them to have their best interest at hand (Wilson, 2012). According to Kahn (2013) “Nurses have ranked highest in honesty and ethics in America since Gallup began including the profession in the poll in 1999” (pp.2). The word trust is continually referenced throughout the ANA Code of Ethics as a basis for effective communication in all working and patient relationships. Trust is the groundwork for not only all nursing care but in any professional setting and without it relationships are compromised.
So what is trust? Webster’s Dictionary defines trust the noun as the assured reliance on the character, ability, strength, or truth of someone or something; a charge or duty imposed in faith or confidence or as a condition of some relationship something committed or entrusted to one to be used or cared for in the interest of another (Trust, 2014). According to Changing Minds, (2013) “trust is both and emotional and logical act. Emotionally, it is where you expose your vulnerabilities to people, but believing they will not take advantage of your openness. Logically, it is where you have assessed the probabilities of gain and loss, calculating expected and concluded that the person in question will behave in a predictable manner (pp.1). Dinc & Gastmens, (2013) describe trust as “a belief that our good will be taken care of or as an attitude bound to time and space in which one relies with confidence on someone or something, and as a willingness to engage oneself in a relationship with an acceptance that vulnerability may arise” (p.502). “When we trust others we accept that they will act honestly and that we can depend on them to behave in a predictable way, and that they won’t abuse our trust (Getting Comfy, 2013). Our dependence on those we trust leaves us vulnerable and we are essentially accepting that area of vulnerability: Dinc & Gastmans (2011) states, “Where one depends on another’s good will, one is necessarily vulnerable to the limits of that good will, and gives others an opportunity to harm when one trusts, and shows confidence that they will not take it” (p. 224). Horsager, (2012) discussed the concept of trust in the following statement:
As a leader, you are trusted only to the degree that people believe in your ability. Be open and transparent. Keep people informed. People are often more concerned by what they do not know than what they do. Explain your decision making process and the rationale for your decisions. Admit when there are problems and make relevant information available” (pp.4).
Studies revealed that patients have a pre-existing trust, due to previous experiences with health-care providers, and a confidence in the nursing profession due to their extensive education (Dinc & Gastmens, 2013).
“Authenticity in nursing leadership is often described as the glue needed to hold together a healthy work environment” (Pross & Sherman, 2010, pp. ). The general population has an initial trust in our law enforcement agencies due to trust in the government’s intense application and training process. As infants we learn basic trust or mistrust depending on how well nurtured we are by our parents. Mcleod, (2013) explains, “If the care the infant receives is consistent, predictable and reliable they will develop a sense of trust” (pp.2.). Stockbrokers are trusted with life savings to invest and make sound judgments because they have proven their ability to produce large returns. Pastors are trusted that the sermon they preach is from the Bible, and we have faith, and hope that the Bible is true. Marriages thrive or fail all based on the trust of each other in the
relationship.
There are many facets to what trust actually means for each situation but all require certain factors to achieve that trust. The nurse- patient relationship requires several conditions to establish trust. According to Dinc & Gastmans (2013) “availability and accessibility of the nurse, feeling emotionally and physically safe, feeling at home and valued as an individual, feeling adequately informed, and respectful communication” (p.507). In the professional context of a nurse it begins with a reliance on skills that then has the opportunity to evolve as a relationship is established through communication and actions. Raeve, (2014) states, “Patients appear to trust in a nurse’s skills made manifest through her professional qualifications” (p.157). When we meet someone outside of this context we rarely have and immediate trust of them. Trust in the laymen’s definition is something that is earned, over time and experience of prior social interactions. It’s a confidence and knowing that our closest friends will not do us harm. This is where the nursing profession is unique in that trust is given where no time has been available to earn that type of trust.
Mathias, Pullen & Richard (2010) articulated a deeper understanding of fostering trust with patients:
“A therapeutic nurse-patient relationship is defined as a helping relationship that 's based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient 's physical, emotional, and spiritual needs through your knowledge and skill” (p.4)
In the nurse-patient relationship, trust is built mainly through our ability as well as demonstration of benevolence by providing care with their best interest in mind as well as open communication. Mathias, Pullen. & Richard (2010) listed the following as guidelines for nurses to establish trust with their patients:

1. Introduce yourself to your patient and use her name while talking with her. A handshake at your initial meeting is often a good way to quickly establish trust and respect.
2. Make sure your patient has privacy when you provide care. Be sure that her basic needs are met, including relieving pain or other sources of discomfort.
3. Actively listen to your patient. Make sure you understand her concerns by restating what she has verbalized.
4. Maintain eye contact. Remember, too much eye contact can be intimidating. Smile at intervals and nod your head as you and your patient engage in conversation. Speak calmly and slowly in terms that she can understand. Your voice inflection should say “I care about you.”
5. Maintain professional boundaries. Some patients need more therapeutic touch, such as hand-holding and hugging, than others and some patients prefer no touching. Always respect different cultures (pp.2).
Common phrases containing the concept trust includes: trust and obey, in God we trust, trust is a two way street and trust your instincts. After analyzing all the uses of the concept of trust and what they have in common, I came up with the following critical attributes: Belief in ability and effectiveness to do something Genuine care and consideration for the best interest of all parties Interests are considered and respected
Integrity displayed through consistency of action.

Model case
A patient is being admitted for an outpatient surgery, the nurse enters and introduces herself, tells her how long she has been a nurse and explains the process of what she will be doing. She then explains what will come throughout the surgical process from admission to recovery (belief in ability and effectiveness to do something). As the medication list is reviewed the nurse notices that the patient has a medication that is contraindicated with another she is taking and discusses this with the patient. The patient then expresses that she has been having side effects that she did not realize were from those the mix of medications. She thanks the nurse for noticing the mix up and states she feels so grateful to have her as her nurse today (genuine care and consideration). The nurse tell the patient she has to shave the groin area for the procedure. The patient appears somewhat apprehensive, so as the nurse pulls the curtain she explains what she will be doing and uses a towel to cover exposed areas as she works (privacy and respect). The surgical bath is prepared as the nurse walks the patient through the process. The patient is a little more comfortable this time and as she is given a towel to cover exposed areas, she is more helpful as the nurse washes (consistency of action). Next the nurse must start the IV, the patient expressed her concern that the last time she was poked multiple times and that no one would listen to her when she told them the best placement. The nurse acknowledges this information and thanks her. She proceeds to look at the placement the patient prefers and informs her that she will place the IV there. As she finishes up she explains to the patient that although sometimes we can go where you prefer , that it’s not always possible but to always speak up to the nurses because it is helpful (interests are considered and respected). Contrary Case
A patient is waiting in the ER bay, the nurse walks in offering no introduction but hands the patient a gown stating, “put this on only underwear on underneath.” At the same time the nurse starts with a rush of questioning while the patient gets up to pull the curtain herself (no privacy or respect). The patient tries to describe her symptoms and the pain she is in but the nurse cuts her off mid-sentence and tells her to just tell the doctor when he arrives, she is only here to get a history, vitals and start fluids (no genuine care or consideration). The patient inquires as to how long the nurse has been practicing to which the nurse replies, “awhile” (No belief in ability). The nurse then begins to look at patients arm to look for IV placement, the patient tells the nurse easiest placement usually is from past experiences. The nurse tells the patient she hates when people try to tell her how to do her job (interests are not considered or respected). The nurse then walks away and tells the patient she will be back to which a different nurse returns to continue the admission (no consistency of action).

Borderline Case
A patient is waiting for nurse to give her medications. The nurse comes in on time as always with the medications (consistency of action). The nurse remembers to bring in the patients favorite juice to take the pills down with (interests are considered). The patient tells the nurse she needs to use the bedside commode first so the nurse closes the door and tells the patient to push the call light once she has finished (privacy and respect). The nurse returns prepares to give the patient an injection but when the patient asks exactly what the injection is for the nurse does not know and simply responds, “it’s just something the doctor wants you to have.” The nurse then calls another nurse to verify where the shot should be given, all the while the patient is now concerned that the nurse should not be administering the medication (no belief in ability or effectiveness to do something).
Concepts related to trust:
Integrity
Benevolence
Credibility
Confidence
Veracity

Invented Case
A boy spots a rainbow in the sky and is filled with excitement because if he finds the end he knows a pot of gold is waiting for him. The boy tells his best friend who has a special map that he drew just for this occasion and gives it to him to follow (belief in ability and effectiveness). The best friends tells him he wants to go to, that he has always dreamed of this day and so the boy invites him to come along (interests are considered). The two set off on their way to find the end of the rainbow and encounter a fork in the road. The boy admits he has no sense of direction and that every time his best friend chooses which way to go they end up in the right place (consistency of action). Together they decide to go right and before they know it they are at the end of the rainbow. As they approach a leprechaun appears and asks the boys to turn around so they won’t see where he hides the gold, the boys oblige and the leprechaun returns with a pot of gold (privacy and respect).
Illegitimate Case
An illegitimate use of the term “trust”
Definition: Firm reliance on the integrity, ability, or character of a person or thing.
Use: “Trust me, I know what I’m doing.” Antecedents
Consistency
Integrity
Communication
Competence Consequences of Trust Commitment
Cooperation
Therapeutic relationships
Respect
Conflict Resolution

In conclusion, the concept of trust remains a broad concept as a whole however it is better defined as it relates to each circumstance.
Trust is continually evolving in the nurse patient relationship and as we become more educated and socially and emotionally aware, we are better able to assess the context of and redefine the way trust is established for that moment. Knowing the basics of building trust is just a stepping stone to becoming better leaders within our profession as we apply the skills across the continuum from patients to co-workers and other health professionals.

References

Changing Minds. (2013). What is Trust? Retrieved March 8, 2014 from: http://changingminds.org/explanations/trust/what_is_trust.htm
Dinc, L., & Gastmans, C. (2011). Trust and trustworthiness in nursing: an argument-based literature review. Academic Journal, 19 (3), 223-237.doi:10.1111/j.1440-1800.2011.00582.x
Dinç, L., & Gastmans, C. (2013). Trust in nurse–patient relationships: A literature review, 20 (5), 501-516. doi: http://dx.doi.org/10.1177/0969733012468463
Getting Comfy. (2013). Why Trust is the Foundation of Leadership. Retrieved March 5, 2014 from:
http://gettingcomfy.com/2013/12/21/
Horsager, D. (2012). You Can 't Be a Great Leader Without Trust. Here 's How You Build It. Retrieved March 3, 2014 from: http://www.forbes.com/sites/forbesleadershipforum/2012/10/24/you-cant-be-a-great-leader-without-trust-heres-how-you-build-it/
Kahn, J. (2013). Nurses Are the Most Trusted Professionals in America. Retrieved March 5, 2014 from://healthpopuli.com/2013/12/16/nurses-are-the-most-trusted-professionals-in-america/
Mathias, T., & Pullen, R. (2010). Fostering therapeutic nurse-patient relationships. Nursing Made Incredibly Easy, 8(3), 4.doi: 10.1097/01.NME.0000371036.87494.11
Mcleod, S., (2013). Erik Erikson. Retrieved March 10, 2014 from: http://www.simplypsychology.org/Erik-Erikson.html
Pross, E., & Sherman, R. (2010). Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level. Online Journal of Issues in Nursing, 15(1), 1-9.
Raeve, L. (2012). Trust and trustworthiness in nurse–patient relationships. Retrieved March1, 2014 from: http://planetreegrove.com/wp-content/uploads/2012/09/Trust-and-Trust-Worthiness-in-Nurse-Patient-Relationships.pdf
Trust. (n .d.). Merriam-Webster.com. Retrieved March 3, 2014, from http://www.merriam-webster.com/dictionary/trust
Wilson, P. (2012). Nurses Voted Most Trusted Profession Again. Retrieved March 8, 2014 from: http://www.healthleadersmedia.com/content/NRS-287322/Nurses-Voted-Most-Trusted-Profession-Again##