Graduate Nurses' Experiences of Developing Trust in the Nurse-Patient Relationship

Article excerpt

ABSTRACT This paper presents the findings of a qualitative exploratory descriptive study that aimed to explore and describe graduate nurses' perceptions and experiences of establishing trust in the nurse-patient relationship.Trust has been identified in the literature to be a crucial element in establishing an effective nurse- patient relationship.There is little in the literature, however, about the development of trust in the new graduate nurse-patient relationship.This research attempts to address this deficit.With this in mind, in depth interviews were conducted with seven first year registered nurses participating in graduate year programs.These first year nurses were asked to describe what their knowledge, understanding and experience of trust was in the nurse-patient relationship. From the data the themes that emerged were building a rapport, communication, being professional and confidence.The results of this study indicate that before a graduate nurse can achieve a trusting relationship with a patient, they first have to develop a rapport with them. More emphasis, therefore, on teaching communication skills in undergraduate and graduate programs may help to increase the knowledge and skills of new graduate nurses. In addition, including discussions on the factors that are important to building rapport and trust, what being a professional entails and strategies for caring for patients in situations where rapport has not been achieved.This research was untaken as part of a Bachelor of Nursing Honors program.

Received 22 September 2008 Accepted 2 December 2008

Key Words

graduate nurse; trust; rapport; patient; nursing; qualitative


A clear definition of what constitutes trust is difficult to find in the literature. Although trust has been identified in the literature (McQueen 2000; Pask 1994) as a necessary component of the nurse-patient relationship, Washington (1990) believed trust has not been clearly conceptualized. Washington (1990) described nurse-patient trust as a continuing process. This description is also supported by Morse (1991) and Richardson (1987). Meize- Grochowski (1984), however, identified trust as an attitude in which one relies with confidence upon someone or something.Trust has also been described by Hupcey, Penrod and Morse (2000) as nurses' belief in the expectancy that patients can be trusted. In addition, this article identified that patients trust in nurses was a necessary element in establishing a connected relationship between the nurse and patient. Each aspect of trust described here was the premise under which this research was undertaken.

Despite the lack of clarity in defining trust, it is clear from the literature that trust is a major influence on patients' acceptance of care and treatment from health care professionals (Hams 1997; Hupcey et al. 2001; Semmes 1991). Specifically trust has been identified in the literature as being a particularly important element in the nurse-patient relationship (Pask 1994;Wallston et al. 1973).Through a trusting relationship, the patient is encouraged to channel energy into achieving the goal of optimal health instead of wondering about and doubting the reliability of care and information.Trust has therefore, been identified as a key element in establishing and building a therapeutic nurse-patient relationship (McQueen 2000;Washington 1990).

Not only is the development of trust important for the patient but also the nurses. The nurse must demonstrate the ability to develop trust in order to obtain accurate information from the patient, and thereby improve the appropriateness of interventions (Hams 1997; McQueen 2000).There are a number of conditions identified in the literature that need to be in place for trust to be developed (Washington 1990).These conditions include confidence, self reliance and faith that the world will satisfy the needs and provide whatever is necessary. …


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