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

By Belcher, Melanie; Jones, Linda K. | Contemporary Nurse : a Journal for the Australian Nursing Profession, February 1, 2009 | Go to article overview

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


Belcher, Melanie, Jones, Linda K., Contemporary Nurse : a Journal for the Australian Nursing Profession


INTRODUCTION AND DESCRIPTION

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. In addition, Arnold and Boggs (2003) identified that the critical elements of trust involve good communication, knowledge, respect, honesty and commitment.

For a beginning graduate nurse, a trusting nurse-patient relationship can be difficult to develop. Anecdotal evidence suggests that new graduate nurses often do not feel very skilled, comfortable and/or confident at nursing in general nor in establishing effective nurse-patient relationships during their first year of practice (Newton & McKenna 2007; Oermann & Moffitt- Wolf 1997). This in turn is a contributing factor to the attrition rates of new graduate nurses (Beecroft, Dorey & Wenton 2008). In addition, trust can be influenced by the nursing knowledge the new graduate nurse has. Most graduate nurses have new knowledge and skills but have little experience on application, needing to further develop their knowledge through experience. Nurses have a strong interest in developing and enhancing a relevant knowledge base with the aim of clarifying and challenging conceptual foundations (Rogers 1987), thus providing evidence that encourages a critical review of nursing practice (Hams 1997). Through experience and reflection on practice the new graduate nurse is more able to apply theory to practice, expand their knowledge and skills and be a confident practitioner (Duchscher 2008). For new graduates this is of particular interest as they are still developing confidence in their nursing skills and knowledge (Newton & McKenna 2007). Lack of confidence means that new graduate nurses are unlikely to trust themselves and, therefore, would have difficulty building a trusting relationship with their patients (Thorne &Robinson 1988). …

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