In Nurses They Trust

A considerable body of research has shown that trust is an essential feature of effective interpersonal and professional relationships and that no major relationship can exist comfortably and with mutual benefit without trust.

Nurses must be aware of the high level of importance trust plays in the nurse-patient relationship and be able to create an atmosphere that encourages it.

What is Trust?

We are all aware of the concept of trust. Trust is something we value in all of our relationships. But, what is trust? How do we define or describe this phenomenon that is so crucial to our lives and what we do?

There are many global definitions of trust and the literature suggests that there is no clear agreement on how to clearly define the concept. Trust is an extremely complex subject, made all the more confusing by the elasticity of the term.¹

In a recent study I completed on perceptions of trust in healthcare environments I asked the respondents to define trust. The responses, as you can imagine, were wide and varied.

At the end of the study, I settled on the following definition of trust that I think accurately describes the trust necessary in the nurse-patient relationship: The willingness to allow a vulnerability to another person (nurse) based on the expectation that the other person (nurse) will perform certain actions important to the trustor (patient). This definition captures the dynamic nature of trust as well as some of its complexities. 

It is the vulnerability part of the definition that is so representative of the nurse-patient relationship and the role of trust. The loss of control and feeling of vulnerability is an emotion nurses must be aware of in order to facilitate an effective relationship that promotes healing, both physiological and psychosocial.

Nurses & Trust

All inpatient healthcare settings, both acute and long-term, produce a measurable amount of anxiety and feeling of vulnerability for the patient.

Just to put it into perspective, allow me to describe a situation as I often do in staff development sessions to try to elicit an empathetic response to the situation:

Imagine for a moment that you wake up one morning in a different building in a different part of town (hospital or nursing home), in unfamiliar clothing (a hospital gown), in a strange bed (often uncomfortable), with odd noises (call bells, bed alarms, monitors, paging), glaring lighting (those awful fluorescent overhead lights), unpleasant odors (we all know what they are), a stranger lying in another bed four feet away ( a roommate in a semi-private room), and unfamiliar faces darting past the doorway in a seemingly frantic motion (nurses, techs, physicians, transporters).

This scenario is played out everyday in the lives of our patients. The sense of anxiety, loss of control, and vulnerability are overwhelming for many.

Before moving on, let's take brief step back to our nursing school days. For some of us that step may be more like a giant leap back in time, but nonetheless, just as important.

Remember Erik Erikson? He was a psychoanalyst who began writing his theory of human development in the 1950s.

According to Erikson, the first year of life is characterized by the trust-mistrust stage of development. Erikson wrote that infants learn trust when they are cared for in a consistent, warm manner. If the infant is not well-fed and kept warm on a consistent basis, a sense of mistrust is likely to develop. He also wrote that if trust versus mistrust is not resolved once and for all in the first year of life it arises again at each successive stage of development.

I submit that the first year of life in Erikson's eight stages of development is analogous to the first interactions with a patient and nurse. It is crucial that the nurse do everything possible to begin establishing a trust relationship with the patient. Failure to do so may result in a feeling of mistrust, as described by Erikson, which will be difficult to resolve and will likely continue to exist during the patients stay.    

Patients must trust their caregivers and caregivers must trust each other.² When care providers do what they are supposed to do, we trust them; when they stray from their purpose, fail to do what we expect, or violate our perceptions of common sense, we question whether we can trust them.³

Descriptions of Trust

As part of my study on trust, I asked respondents how important trust is. Some of the responses were quite descriptive and help to underscore the necessity of trust in our relationships. The responses include the following:

• "Trust is like a basic food group."
• "Without trust one cannot survive the stressors of the day."
• "Without trust, one has nothing."
• "Without trust you have no basis for a relationship."
• "Trust is a major cornerstone of human interaction."
• "Trust is required as no man is an island."
• "Trust is the mortar of all relationships."

These statements are representative of the role trust plays in our relationships.

The Development of Trust

So, up to this point, we have reviewed what trust is, established that it is important and revisited a human development theory that emphasizes trust as a cornerstone to development.

Now let's look at a method to be mindful of trust in our relationships with patients and help us develop it. As with any type of educational component in our profession, it must be short and simple in order to be effectively implemented within the context of our time-constrained workplace environments.

In an attempt to meet that requirement, I offer a simple acronym for developing nurse-patient trust.

Talk to your patient. Something as simple as a brief conversation can alleviate anxiety in your patient and begin establishing a rapport. Introduce yourself; communicate who you are and explain what you are going to be doing.

Reliability in all that you do. Make sure the patient has a sense that you can be relied upon to do what you say you will do and will follow through.

Urge your patient to be actively involved in their care. Encourage dialogue and questions so that each party has a clear understanding of expectations.

Share experiences with your patient that may help them feel more comfortable. Sense what might be troubling them and attempt to provide some comfort

Truthfulness in all of your communication. Be truthful about the time you have to spend with them. Do not make promises you can not keep.

Simpler Things Matter

We are all so busy completing the important tasks so necessary for our patient's healing process that it is easy to forget some of the basic concepts that make us effective nurses.

It is my sincere hope that this article has increased your awareness of the vital role trust plays in establishing an effective, healing relationship with our patients. Sometimes just a reminder of some of the simpler things we can do make an enormous difference in the lives of our patients.

The work we do is important and often difficult. Let's make sure we are doing all we can to minimize a patient's sense of vulnerability and speed them on their way to recovery.  

References
1. Annison, M.H. & Wilford, D.S. (1998). Trust matters: New directions in health care leadership. San Francisco: Jossey-Bass.
2. Ruscio, K. P. (2004). What works - an essay on trust. In Encyclopedia of Leadership, Great Barrington, MA: Berkshire Publishing Group.
3. Simpson, R.L. (2002). Stakeholders in trust: Leadership in the information age. Nursing Administration Quarterly, 26(3), 76-79.

David Holland is assistant professor, Department of Public Administration, Kean University, Union, NJ.