Trust

Trust is a very pertinent concept in health care today. In health care, trust is in every transaction. Trust is most relevant in situations where uncertainty is highest (Robbins, 2016). Trust is the core foundation of the nurse-patient relationship (Stolt et al., 2016)

In the Theory of Bureaucratic Caring, Ray (1989) introduces trust as an integral part of ethical nursing care (Glasser, 2014) and a humanistic expression of caring (Hines, 2017). Trust is high on the global agenda (European Commission, 2012; Stolt et al., 2016; World Health Organization, 2005). Trust is a relational bond, an intimate offering, a consequence of history, a response to ethical treatment, and a necessity in the face of unfamiliarity and uncertainty. The multi-dimensionality of trust makes it difficult to define (Hosmer, 1995; McCabe & Sambrook, 2014).

Trust and Social Engagement

As described by Blau (1964) in the Social Exchange Theory, trust is a key aspect of social relations (Osino, Yu, Baalola, & Cooper, 2016). Trust is necessary for successful social interaction of diverse groups and without it, a bureaucracy cannot create culture (Potter & Wilson, 2017). In review of the theory of bureaucratic caring, caring is the core emphasis, and trust influences our willingness to engage with others (Potter & Wilson, 2017).

The Origin of Trust

Generalized trust is the belief that most people are trustworthy (Mewes, 2017). Mewes (2017) and Robbins (2016) share similar views of the origin of trust. Mewes (2017) states that generalized trust is rooted in optimism and a sense of control (Ross, 2011; Seligman, 1997; Uslaner, 2002). Trust is a creation of positive expectations, unconditional hope, and a matter at hand (Robbins, 2016). Trust is a belief that is bound to time and place (Charalambous et al., 2016; Washington, 1990). Trust, however, increases when the patient and provider have more time together (Zarei et. al., 2015). As described by Dinc and Gastmans (2012), trust is a process, a relational phenomenon within the context of the nurse-patient relationship (Dinc & Gastmans, 2013). The research supports that the patient values the asset of time. As noted by Chenard (2014), each caring interaction requires time for the nurse to understand patient needs and design care to the patients’ needs and preferences (Charalambous et al., 2016; Wessel et al., 2010).

The Fragility of Trust

Trust is a unique concept that is critical in health care and delicately fragile. As Laurence (2015) describes, generalized trust is resistant to change; however, significant life events (Zarei et al., 2015) can have a powerful influence. Levi (1998) well notes the fragility of trust when he said that destroying generalized trust is much easier than creating it (Zarei et al., 2015). The loss of trust is devastating for the patient. As Sacks and Nelson (2007) explain, an absence or loss of trust can cause the patient unsettling emotional suffering (Charalambous et al., 2016).

Trust is a Decision

Trust is an intentional decision based on belief and confidence in the provider and organization. As described by Dinc and Gastmans (2012), trust has
preconditions of belief, consistency, observation of moral character and competence (Charalambous et al., 2016). Patients must evaluate their need and willingness to trust because when they do, vulnerability is present and acknowledged (Baier, 1986; Gonzalez, 2017; Sellman, 2007).

Trust as an Attitude

Luhmann (1979) viewed trust as an attitude dependent upon the specific situation (Gonzalez, 2017). Sellman (2007) viewed the willingness to trust as part of an attitude (Gonzalez, 2017). Watson (2012) argued that trust is an attitude influenced by caring (Brousseau, Cara & Biais, 2017), and it guides behaviors (Brousseau, Cara, & Biais, 2017; Cara, 2004). In fact, Watson (2008) urges the nursing profession to develop and sustain the authentic help-trust relationship, for it is essential to human caring (Gonzalez, 2017). Carter (2009) states that trust is more fundamental than beneficence, veracity, and non-maleficence because without trust, no one would have reason to take on such duties (Dinc & Gastmans, 2013). Ray (1989) describes that ethical factors of morality, trust, and respect contribute to the meaning of caring and guide practice (Glasser, 2014).

The Trust-Confidence Connection

Radwin and Alsten (1999) define trust as "the confidence that care would be appropriate, reliable, and as successful as possible" (p.332), and Carter (2009) describes trust as confidence in someone or something (Charalambous et al., 2016). A patient offers trust because they are confident that the provider's primary concern is their best interests (Gonzalez, 2017). The foundation of confidence in nursing care is centered around the needs and preferences of the patient (Charalambous et al., 2016; Keller 2008; Wessels et al., 2010). In fact, confidence is a primary attribute of trust, and trust cannot exist without it (Dinc & Gastmans, 2012; Gonzalez, 2017).

Attributes of Trust

Compassion, an attribute of trust, is an intentional expression of caring and connects self to others (Hines, 2016). As Rutherford (2014) describes, compassion is a nurse's actions to alleviate discomfort or suffering, and these actions influence the patient's trust (Rutherford, 2014; Staughair, 2012). Patients become ill and seek protection from the nurses they trust, hoping for an opportunity to flourish again (Rutherford, 2014, Sellman, 2005).

Antecedents of Trust

Professional competence is an antecedent of trust. A patient weighs their perceptions of their nurse, and professional competence is a deciding factor (Charalambous et al., 2016). When the patient offers trust, this action enables the nurse to better assess and treat her patient more proactively. These outcomes please the patient, increase their confidence in their nurse and the patient receives more individualized care (Pengue & Kearney, 2015).

When trust is given, the consequence is vulnerability. Although patients have an increased vulnerability in health care because of their lack of technical knowledge (Zarei et al., 2015), vulnerability is a consequence of trust because one person cannot control or predict another’s actions. As Koskinen and Lindstrom (2013) explain, the nurse and the patient have a shared presence and are willing to engage with each other, which means accepting vulnerability (Bunkers, 2015). 

Empirical Referents of Trust

As Ray and Turkel (2010) explain, the empirical referent of patient satisfaction comprises the patient’s health care experience and the social and economic factors of society (Chenard, 2017). Patients’ trust consists of meeting needs, keeping commitments, and showing deep concern for their health. A patient’s satisfaction is determined by how much the care experience differs from expectations (Fox & Storm, 1981; Hawthorne et al., 2014).

The second empirical referent of trust is patient outcomes. The triad for patient-centered care is quality care, safety, and satisfaction (Brousseau et al., 2017). Nurses engage with patients face-to-face, respect their uniqueness, and support their individual needs, which nurtures patient trust (Charalambous et al., 2016; Rchaidia et al., 2009). Trust directly influences adherence and willingness to seek care (Zarei et al., 2016).

The Relational & Organizational Foundation of Trust

The bureaucratization of health care has changed the meaning of caring within an organization (Glasser, 2014; Ray, 1989). Interpersonal trust is part of the patient-clinician relationship, and impersonal trust is part of the organizational relationship with the patient (Dinc & Gastmans, 2012; Gonzales, 2017; Luhman, 1979; Trojan & Yonge, 1993). These constructs of trust are different, but they are interrelated (Dinc & Gastmans, 2013).

Trust is given when needs are met, and the provider’s promises are kept (Zarei et al., 2015). Ray’s theory (1989) represents the concept of trust from a different perspective for nurses. Nurses easily embrace trust in the art of caring; however, the patient’s preconditions for trust require the organizational structure. As Ray (1989) describes in her theory, caring is the bond of the entire organization, and if we intentionally focus on this bond, we can achieve the outcomes we seek (Potter & Wilson, 2017).

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