Trust: a critical element in critical care nursing

All nurses, regardless of specialty, should strive to develop a trusting relationship with their patients. This relationship paves the way for obtaining the accurate and pertinent information necessary to form correct nursing diagnoses. In a critical care unit, this accuracy and trust is essential caused by the intensity of the environment. Support systems are weakened with family members being separated and allowed to visit for only short periods of time. Family members may see a loved one as never seen before, appearing absolutely helpless. A trusting relationship with the critical care nurse could help reinforce and strengthen the weakened support system. Professional nurses spend the greatest amount of time with consumers of health care. This situation places them in a position to influence life-styles. Seeking further assistance or following advice may depend on the quality of the nurse-patient relationship. Specifically for critical care and long-term situations, trusting relationships may make a long, intensive illness less traumatic. Trust built in the critical care area may provide the basis for positive nurse-patient relationships developing throughout the hospitalization and during future interactions with professional nurses.     

Nurse-patient relationships in palliative care

AIM: The aim of this paper is to report a study exploring aspects of nurse-patient relationships in the context of palliative care. BACKGROUND: Although there are numerous studies addressing nurse-patient relationships, little research has focused on these in the context of palliative are. Furthermore, no previous study has examined the relationship in the Chinese context. METHODS: Qualitative data were collected from 10 hospice nurses and 10 terminally ill patients by means of open ended unstructured interviews. Respondents were asked to reflect on practices and incidents that would allow an understanding of the meaning of nurse-patient relationships in palliative care. RESULTS: Four major categories emerged from the perspectives of patients and nurses: (1) forming a relationship of trust; (2) being part of the family; (3) refilling with fuel along the journey of living and dying; and (4) enriched experiences. Responses revealed that a relationship of trust is formed, and that nurses are not only regarded as health professionals, but also become part of the family or a good friend. Nurses who develop trusting relationships demonstrate a holistic approach to caring, show their understanding of patients' suffering, are aware of their unvoiced needs, provide comfort without actually being asked, and are reliable, proficient, competent and dedicated in their care. CONCLUSION: Trust, the achievement of the goals of patients and nurses, caring and reciprocity are important elements of nurse-patient relationships in palliative care. Such relationships not only improve patients' physical and emotional state, but also facilitate their adjustment to their illness, ease pain and can ultimately lead to a good death experience. It is nurses' personal qualities and skills, which are embedded in these relationships, that constitute excellence in nursing care. Nurses also derive satisfaction and are enriched through the relationships.     

A concept analysis of trust

Trust is an important and pervasive concept In nursing, it has been considered primarily from two perspectives Clinically, it is an important aspect of the nurse-patient relationship Organizationally, trust is associated with various outcomes and levels of effectiveness Much of the nursing literature that discusses trust relies upon vague conceptualizations or borrows from other disciplines The absence of a clear conceptualization of trust has been cited A core concept of trust is presented which is applicable to nursing in both clinical and organizational settings Established methods for concept analysis are supplemented by a sequential step model developed by the author The concept is developed as both process and outcome, and the relationships of the two states to measurement of the concept are identified The utilization of the core concept in context-specific instances is discussed, and suggestions are made for further research     

The nurse-patient relationship results of an examination about relationships between patients and nurses in hospitals

The nurse-patient relationship has received particular attention in the relevant literature. For patients in life threatening and existentially challenging situations, nursing activities often require a close intimacy. A good nurse-patient relationship is a precondition for effective nursing interventions, but by itself also contributes to the healing process. How such a relationship is realized in everyday nursing situations remains, however, unclear Literature predominantly details normative expectations on the nurse-patient relationship that are based on nursing theory or concepts from humanistic psychology. The operationalisation of these concepts into nursing practice is not given. In order to answer the research question "How do nurses experience their relationship with the patient?" qualitative interviews were conducted. Thus, the nurse-patient relationship was explored from the perspective of the nurses and considered in the context of their specific working situations. Nurses related their experiences, emotions and stress resulting from different kinds of nurse-patient relationships. Data were collected, organised and analysed following Giorgi's 1985 phenomenological analysis. Results show an ambivalence by nurses between closeness and distance in their relationship with patients. These relationships also show a polar vascillation between, for example, "sympathy" and "antipathy", or "being able to help" and "helplessness". The development of the relationship is often not very professional and depends on the specific situation and those individual persons participating in it. It is also apparent that those models of the humanistic psychology which have been discussed in nursing contexts cannot serve as such as a basis for the development of the nurse-patient relationship. A particular aspect of developing relationships in nursing are nursing interventions which necessitate bodily contact and physical work with patients. Concepts including these aspects of nursing can serve as valid and concrete starting points in order to find a way unique to nursing to create effective relationships with patients.     

The nurse-patient relationship in cancer care as a shared covenant: a concept analysis

The concept of the nurse-patient covenant was explored using a multiple-method research design. Analysis of the literature (167 references) was the basis for 2 focus group interviews (12 nurses) and 8 semistructured patient interviews. Attributes, antecedents, and consequences were identified through an analysis of findings across all data sources. The nurse-patient covenant in cancer care is defined as an enduring relationship, embodying caring benevolence and contextually negotiated reciprocity. It is preceded by the demonstration of nursing competence as a manifestation of nursing tradition and leads to patients' trusting and entrusting nurses, the emergence of personhood and professionhood, and benefits and obligations.     

Developing trusting, caring relationships: home care nurses and elderly clients

Trusting as an area of research has not been critically examined in nursing research literature In this study, nurses working in home care and elderly clients were interviewed to ascertain the process of developing a trusting relationship Data were obtained from seven home care nurses and six elderly clients who were interviewed from one to three times The data were analysed using grounded theory methodology and sorted using Microsoft Word software on a Macintosh computer The core category which was identified in the data was labelled 'trusting, caring relationships' This core category encompassed trusting which is developed and the caring which the nurses provide Home care nurses and elderly clients moved through four phases initial trusting, connecting, negotiating, and helping The findings have implications for novice nurses working with elderly people, as well as for programme development and education More research needs to be done on trust in different contexts to assist all nurses in establishing nurse–client relationships     

Paediatric nurses, children and the development of trust

Nurses in paediatric settings work hard to develop trusting relationships with the children in their care. There are, however, barriers to these trusting relationships, because nurses are often involved in painful or frightening procedures for children, and sometimes parents may hamper the development of trust between nurse and child. Nurses use a range of strategies to try and gain confidence and co-operation from children, but recognize that at times it is necessary to simply restrain and carry on. In exploring the experiences of paediatric nurses, it became evident that the need to carry out painful procedures while trying to maintain relationships with children was taken for granted in this type of practice setting. What did not appear evident to the nurses was the dichotomy that they viewed trust as really important, but considered breaking trust to be essential.     

Explorations of a trust approach for nursing ethics

Trust has long been acknowledged as central to nurse-patient relationships. It, however, has not been fully explored normatively. That is, trust must be examined from a perspective that encompasses not only reliability and competence, but also good will within nursing relationships. In this paper, we explore how a trust approach, based on Annette Baier's work on trust in feminist ethics, could help inform future developments in nursing ethics. We discuss the limitations of other approaches such as those based on contracts, paternalism, and care. By drawing out central features of Baier's theory, we demonstrate how it can help overcome the problems of these previous models. In doing so, we emphasise the importance of combining the ethics of care and justice, acknowledging vulnerability and the potential for evil in nursing relationships, and politically situating the ethical concerns of nursing.     

Care: what nurses say and what nurses do

Caring is neither simply a set of attitudes or theories, nor does it comprise all that nurses do. Nursing care is determined by the way nurses use knowledge and skills to appreciate the uniqueness of the person they are caring for (changing the care noun into a caring verb). The purpose of this article is to present a range of contemporary nurse theorists' ideas on caring and to examine these ideas using the backdrop of nursing as practiced in both Australia and Canada to demonstrate a range of national and international similarities and theoretical beliefs. Caring relationships set up the conditions of trust that enable the one receiving the care to accept the help offered, underpinning the nurse-patient relationship or the therapeutic relationship. Caring is always specific and relational such as that found in the nurse-patient relationship. We believe that caring theory has much to offer nursing practice worldwide. Caring must be considered in the caring context because the nature of the caring relationship is central to most nursing interventions. Nurses need to be able to actually practice caring rather than just theorize about it-using caring theories to inform their practice.     

Being authentic and being a chameleon: nurse-patient interaction revisited

This paper explores contradictory understandings of nurse-patient interaction arising through an exploration of 'being authentic' and 'being a chameleon'. The concepts arose during a critical praxis research study exploring nurse-patient relationships in the context of life-threatening or terminal illness. Being authentic can be understood as a dominant view in the nursing literature of the nurse-patient relationship, incorporating the value of being genuine. However, we argue that this concept offers only a partial and inadequate framework from which to understand nurse-patient interaction. The paper argues that nurse-patient relationships develop intersubjectively, with both the nurse and the patient choosing to reveal or conceal aspects of themselves in response to their interactions. Intersubjectivity as a concept provided the nurses in this study with a means for understanding how the nurse and the patient each contribute to interactions; nurse-patient relationships being understood as mutually constructed. These ideas are explored in this paper using examples from the nurses' stories, along with the implications raised for nursing practice.     

An examination of senior nursing roles: challenges for the NHS

Wellhouse NHS Trust moved its inpatient services to the new Barnet General Hospital in 1997 and merged with Chase Farm Hospital NHS Trust in 1999. To assist with the trust's management of resulting changes in care provision, a short project was conducted to examine the nursing services provided by ward managers (20) and senior nurses (27), that is nurses who undertake specialist/ advanced nursing practice. The project also aimed to present the views of the stakeholders (66) with regard to nursing in the trust and nurse-led services. The project involved two stages of data collection--focus groups and postal questionnaires. The project provided a great deal of information about the nursing service within the trust: a profile of the senior nurses, roles and responsibilities, skills and competencies, training and development, and support needs for their roles. The findings considered a number of issues: (i) employment--diversity of grading for posts; (ii) work roles--conflicts in role composition; (iii) stakeholders--perspectives of stakeholders on nursing. It is anticipated that the findings are not unique to the one trust and that they will contribute to the development of new clinical career pathways for senior nurses within the trust.     

Preconditions needed for establishing a trusting relationship during health counselling - an interview study

Aim. To examine the preconditions needed by district nurses to build a trusting relationship during health counselling of patients with hypertension. Background. Trust has been found to be an important aspect of the patient–nurse relationship. Little research has focused on how trust is formed in patient–nurse relationships or the conditions the development process requires when working with health counselling; in particular not in relation to hypertension. Design. Qualitative study. Method. Qualitative data were collected through open‐ended interviews with all (10) district nurses from three primary health care districts of western Sweden. All interviewees work with the health counselling of patients with hypertension. A latent content analysis was performed with thematic coding of the content of the interviews. Results. The first theme that emerged from the analysis, the nurses’ competence, describes the nurses’ consciousness of their method of expression, both oral and non‐verbal, as well as their pedagogical competence and their ability to be reliable in their profession. The second theme, the patient meeting, describes the continuity in the patient meeting and creating respectful communication. Conclusion. The results show an awareness of preconditions influencing building a trusting relationship. When creating a trusting relationship the communication and pedagogical competences of district nurses have considerable importance. Despite this awareness they state that it is easy to fall into a routinised way of working. Relevance to clinical practice. The implications of this study might be used as support and guidance for district nurses when developing their competence in health counselling in relations to patients with hypertension. This knowledge is also important when planning for nurse‐led clinics for this patient group.     

Therapeutic relationships in critical care nursing: a reflection on practice

AIMS: The aim of this paper is to gain a greater understanding of the emotional intelligence required to form therapeutic nurse-patient relationships in the context of critical care nursing. CONTEXT: There is currently a demand for patient-centred nursing in all aspects of health care to improve both quality of care and consumer satisfaction. Central to patient-centred care is the presence of a therapeutic nurse-patient relationships, but the development of these relationships present a challenge in the acute and technological world of critical care nursing. THEORETICAL FRAMEWORK: Using Titchen's Skilled Companionship Model as a guide as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a reflection on a relationship that the author developed with a patient and his family encountered in her practice as a critical care nurse. REFLECTIVE CONCLUSIONS: Engaging in therapeutic nurse-patient relationships can expose nurses to emotional pain in the context of critical care nursing. The process of reflection can facilitate critical care nurses in the development of the emotional intelligence required to develop and maintain these relationships and this enhances the care of critically ill patients and their families.     

Admitting hospital patients: a qualitative study of an everyday nursing task

In recent years new modes of nursing work have been introduced globally in response to radical changes in healthcare policies, technology and new ideologies of citizenship. These transformations have redefined orthodox nurse-patient relationships and further complicated the division of labour within health-care. One distinctive feature of the work of registered nurses has been their initial assessment of patients being admitted to hospital, and it is of interest that this area of nursing practice remains central to the registered nurse's role at a time where other areas of practice have been relinquished to other occupational groups. This qualitative study, drawing on conversation analysis and ethnographic techniques, explores this area of everyday nursing work. Initial nursing assessments have attracted considerable interest in the nursing literature, where it is clearly stated that assessments should be patient centred and seen as the important first step on the road to a therapeutic nurse-patient relationship. Results from this study lead to the conclusion that the actual nursing practice of patient assessment on admission to hospital is at odds with the recommendations of the literature and that a more routinised, bureaucratic form of work is devised by nurses as a means of expediting the process of admission.     

护患关系信任度及其影响因素

目的探讨护患关系信任度并分析其影响因素,为提高护患关系信任度,改善护患关系提供理论依据。方法采用护患关系信任度量表对136例住院患者进行问卷调查,总结各条目评分情况并分析护患关系信任度的影响因素。结果本组136例住院患者中,信任度量表中5个维度对知识和技术的确信、一贯性、尊重、安心感和对未来的信心得分分别是（3．62±0．26）,（3．47±0．32）,（3．59±0．61）,（3．58±0．73）,（3．35±0．79）分;得分最高的条目为按床头铃后护士很快就回应（3．92±0．35）分,得分最低的条目为护士对我的指令太多,我感到拘束,不大自由（2．75±0．10）分;多元回归分析提示,患者年龄、住院时间、付款方式是住院患者护患关系信任度的影响因素（t分别为11．940,2．537,4．362;P〈0．05）。结论护理人员应重视影响护患关系信任度的相关因素,改进护理措施及方法,以改善护患关系,提高护患关系信任度。     

Negotiating realistic and mutually sustaining nurse-patient relationships in palliative care

Barthow C. International Journal of Nursing Practice 1997; 3: 206–210
Negotiating realistic and mutually sustaining nurse–patient relationships in palliative care
This paper uses a literature review to question the proposition that nurses will be permitted to care for the psychosocial and spiritual needs of patients in the manner that is frequently presented as the nurses role. Second, it will explore qualities in nurse-patient relationships that can be not only helpful to those who are cared for but also can be a mode of sustenance to the nurse. Issues explored are the social construction of the nurse–patient relationship, reality checking, balancing emotional and cognitive functions in nursing, focus of nursing commitment, power issues, reciprocity and boundaries. Palliative care nursing will be referred to in relation to these themes as it is an area of nursing which highlights the increasing focus on psychosocial care. For this reason questions of what is realistic and sustainable for the nurse are of prime importance.     

预防医院Ⅱ型暴力的医护患关系结构方程模型构建及分析

目的构建预防医院n型暴力的医护患关系结构方程模型,探索影响医院Ⅱ型暴力的主要路径。方法便利抽样法选取福建省某所三级甲等医院的住院患者及其所在科室的医生和护士为研究对象,采用中文版维克森林医师信任量表、中文版医师信任患者量表、语言与社会交往问卷、语言与社会交往问卷-患者问卷、患者满意度问卷对其进行调査。结果患者信任医生(P<0.01)以及护士语言与社会交往能力(p<0.05)影响患者满意度,路径系数分別为0.73和0.24;医生信任患者对患者满意度没有显著性影响(P>0.05),路径系数为0.06。结论预防医院Ⅱ型暴力的关键影响因素是患者信任医生以及护士语言与社会交往能力。     

The modification of emotional responses: a problem for trust in nurse-patient relationships?

This article examines one aspect of the criticism of inauthenticity that can be levelled against the trustworthiness of professional relationships in general and nurse-patient relationships in particular. The overall question is: are such relationships inherently trustworthy or untrustworthy, from the patient's point of view? The author concludes that, in spite of legitimate grounds for concern, and while it remains true that nurse-patient relationships may be untrustworthy, they are not inherently so for reasons of inauthenticity relating to emotional labour. The arguments used to defend this claim take their force from the idea that different criteria may be needed to assess the authenticity of nurse-patient relationships from those used to evaluate authenticity in ordinary social relationships. The utility of Hochschild's idea of 'deep' acting, as offering a useful model for the management of emotions in nursing, is examined and rejected.     

The ethics of relation: public health nurses and child protection clients

AIM: The aim of this paper is to show how a framework of relational ethics may be used in establishing trusting relationships with at-risk families. BACKGROUND: Public health nurses have historically carried out assessment and monitoring of parenting within the family home, particularly with at-risk families. In this role, they are placed in the position of simultaneously supporting and policing the family. A trusting relationship may be difficult to develop if parents feel threatened by the surveillance aspect of home visiting and the threat of action (such as removal of children) being taken against the family. DISCUSSION: Development of optimal trust relationships may be a challenge when families are experiencing powerlessness and oppression. The four themes of relational ethics--mutual respect, engaged interaction, embodiment and creating environment--provide a framework for developing trusting relationships with families. CONCLUSION: It is possible to have a moral and trusting relationship with at-risk families, but this needs to based on critical self-reflection by nurses and mutually respectful nurse-family relations.