Trust is an interpersonal and essential element of all patient-nurse Implications for nursing practice: Reflection on a trusting relationship with the patient is had no sense of trust and their lack of knowledge about surgery made it difficult to. A positive and trusting nurse-patient relationship is the basis for the delivery of . The nurse acknowledged that it was difficult to form a relationship with the. The 'difficult' nurse–patient relationship: Development and evaluation of Nurses in most clinical settings experience difficult 'nurse patient Graduate nurses' experiences of developing trust in the nurse–patient relationship.
Developing effective and caring nurse-patient relationships
Hope emerged as trust developed and patients began to trust themselves and others . Experiences of trust was associated with feeling safer, more confident, being heard and less angry; the participants felt accepted, cared about and a sense of belonging .
The risk of complications in home births was counterbalanced by confidence in the midwife . Experiences of trust were also related to being respected, feeling accepted as a person, not objectified  and confidentiality . In patients with myocardial infarction, trust in powerful others led to less interest in their own ability to control the illness . For older adults in long term care, trust meant opening up to the nurses on a summer holiday for people suffering from dementia about issues they might otherwise not have revealed to others .
Trust was central for patients suffering from chronic mental illness . Three categories of trust were developed in this context: The patient-nurserelationship Trust was fundamental for caring in the patient-nurse relationship essential for the establishment and maintenance of a therapeutic alliance .
In the context of the transition from hospital to home, one participant expressed that she needed to trust someone familiar with her own experiences and that she tried to stick to one person p. In a study on patients with dementia, two types of relationships were categorised: In the present review, this category had two sub-categories: Trust was associated with nurses taking time, sitting down and answering questions, exhibiting interest and showing concern as well as sharing experiences and emotions .
Trust was created by nurses who demonstrated caring by positive attention caring actions and attitudes . In patients with chronic kidney disease, the sense of security was nurtured when the staffs were available and the feeling of trust was nurtured through the dialogue between the staff and the patient . Providing holistic care and exhibiting genuine interest as well as specific care in accordance with individual needs were described.
The patients with pulmonary oedema reported high trust in the care providers, particularly in their medical expertise . Confidence in midwives was highlighted as it counterbalanced the risk of possible complications . One study described that when a nurse responded to a patient in a trustworthy way, a relationship characterized by trust and connection developed .
Communication between the Trustor and Trustee Trust was described as being in tune with the other . This may be associated with communication such as nurses informing about risk, maintaining confidentiality, interacting with and relating to patients as adults, acting as advisor or patient advocate, being engaged and providing assistance. Prior friendship with the midwife was described as a great emotional benefit, while trust was related to being a good friend, a part of the family  or being familiar .
Being heard and understood in such a relationship was important for trust, as were openness and willingness to talk and listen .
The need to engage in conversation was highlighted, for instance trying to clarify the content, adopting a listening attitude and demonstrating that one is trying to understand . Here, trust refers to an individual professional as opposed to the care system. Patients reported increased autonomy and the emergence of trust in such two-way relationships .
The following two sub-categories were described: For those with schizophrenia, the act of bringing service to the patient in a caring manner may result in fostering trust. Patients with schizophrenia who trusted in the nurses believed that the team cared about them . Several papers illuminated the link between trust and competence. Trust was linked to competent nurses who managed situations .
Other issues related to competence were discussions about medical issues and abuse, being knowledgeable and thorough as well as a long-term caring relationship that made the provider familiar with and interested in each individual . One study associated trust with professional factors such as maintaining confidentiality and interacting with patients as adultswhile others referred to the need to respond in a trustworthy way .
In the context of tracheostomy tube change, patients needed to prepare themselves psychologically, which required trust that the nurses had the necessary competence to perform such a complex task . Nurses who were experienced as professional, flexible, empathetic, confidential, related to the patient as an adult and remained calm were deemed trustworthy whereby a foundation for the therapeutic contract could be laid .
Trust Related to the Organizational level Organizational issues were mentioned such as staff being instant accessible  ; availability and easy to contact . A set time to contact the therapist and negotiation of a formal agreement between patient and therapist were described . Time was an issue because it is required to develop the relationship  and to sit down and listen .
A study of factors that enable trust in the context of public mental healthcare highlighted the importance of creating trust through dialogue and not through the system, stating that the participants in their study never mentioned trust in the latter .
How do patients describe the meaning of trust in nursing? These experiences comprise both a feeling and an awareness of trust as described in this review.
Such core features are reasonable and lead to the feeling of being taken care of, dispensing with the need to ask questions, relying on the other, feeling safe and better able to manage the illness, thus these features constitute a key enabler in overcoming problems.
Facilitating and fostering trust are related to communication, nurses being open, competent, practical, interested, concerned, confident and sharing control, which is in line with literature which describes trust as a process and outcome .
These actions are opportunities to create faith, hope and meaning as described in previous literature . Predictability and empowerment are created when patients are informed, prepared or know in advance, leading to early detection of symptoms, better ability to manage life, trust in oneself, hope and being more open to pushing oneself. Trust has been characterized as reliance on and confidence in others and its basic attributes as time, reliance, risk and fragility .
Feeling safe, being provided with shelter and a home-like environment are associated with a sense of confidence and respect. The patient-nurse relationship is intimate and personal for the latter.
For nurses to be experienced as trustworthy, they must exhibit the following qualities: The review reveals the importance of communication between the trustor and trustee for the creation of trust. Being heard and understood is essential for the patient. Previous findings highlight trust as the basis of the relationship between healthcare professionals and patients  -.
In the literature there are also different concepts of relationships for example, care relationships, nursing relationships, interpersonal relationships, therapeutic relationships and caring relationships and it is not always clear what the differences are and also these concepts are sometimes used interchangeably. In a caring relationship the whole person is included, which is physical, mental and spiritual aspects.
The caring relationship could enable human growth. A caring relationship could be seen as a mutual relationship that requires trust between the both parties. Within the caring relationship the caregiver gives a promise of care and implicit promises of alleviation of suffering and also a promise of togetherness and personal contact [ 5 ]. The caring relationship can be understood as balancing between vulnerability and dignity i.
An uncaring relationship was described when the person was an object to be cared for and the caregiver performs the task. When the caring relationship is absent the person is left alone in their anxiety, pain and fear [ 5 ]. Naturally, we encounter each other with trust which is fundamental to all social intercourse.
The trust makes us vulnerable when we expose ourselves to each other and trust means that we expect the other to preserve our dignity. In nursing care, maintaining a helping relationship is a way of caring for human needs.
- Developing effective and caring nurse-patient relationships
- How to build and maintain trust with patients
This caring relationship means that the nurse focus on needs, limitations and the potential of the person [ 9 ]. The nurses have to be authentic and adaptive to the person in need of care and the situation [ 4 ].
The relationship in nursing has been studied widely, particular in psychiatric care [ 11 ] and in palliative care [ 1213 ]. A realist review of literature [ 10 ] shows clearly the importance of the relationship between district nurses and persons in need of palliative care.
It also shows that few studies explore what a relationship meant and what its purpose is to the nurse. Another important reason for study the relationship further is that the literature has shown that care suffering arises from negative relationships despite the fact that it is supposed to promote health and well-being [ 14 ].
The nurse is responsible for the caring relationship and that the relationship turns out positive. A total of 24 RNs and 18 DNs received letters with information about the study and they were asked to participate in an individual interview. Thirteen RNs and 11 DNs agreed to participate. All participants were female. The participants were given written and verbal information about the study and that their participation was voluntary with possibility of withdrawing without any explanation at any time.
Assurance was given that the presentation of the findings would be used in such a way that none of them as individuals could be recognized by others. Context and Concepts The four chosen territories represent one city area and three remote areas. In each territory both healthcare managers in primary healthcare and healthcare managers for social welfare services are responsible for home care service. This means that in the same territory, both county council and the municipality are responsible for healthcare.
The DNs were employed by the county council and responsible for healthcare in ordinary homes. The RNs were employed by the municipality and responsible for healthcare in sheltered housing. The DNs have no staff they can delegate assignments to and the RNs have enrolled nurses who they can supervise and delegate some assignments to. All participants had extensive experience of home visits as well as distance-spanning technology especially telephone contact, in their daily work in home-based nursing care.
The policy in Sweden is that the most care should be carried out at the healthcare center, where DNs work, and only for special reasons DNs should make home visits. The RNs do not need a prescription but can decide when they make home visits. The participants had a large variation in the distance travelled to the person in need of healthcare at home.
In present study the idea of a nurse is used and includes RNs and DNs. Primary nurse means a nurse who has primary responsibility for nursing care and healthcare for a person. Stand-in nurse means a registered nurse who is deputize for a primary nurse. The conception home includes ordinary homes and sheltered housing. In Sweden sheltered housing can be a residential home and a nursing home. Distance-spanning technology in the present study means a telephone, web camera and videoconferencing equipment.
Data Collection and Analysis Data was collected through open individual interviews. The interviews were tape-recorded and lasted for minutes. The interviews were transcribed verbatim. The analysis started with a reading of the text several times to get a sense of the whole [ 17 ]. The interview text from the RNs and DNs were viewed as one text and was later divided into two main areas, relationship and encounter, which were identified in the text and analyzed separately.
All interview text was the focus for analysis. The present study is an exploration of the relationship and the analysis of the encounter will be published elsewhere. The analysis continued with a thematic content analysis inspired by Berg [ 15 ], which meant that the text about relationship was read several times and then divided in meaning units and condensed.
The condensed meaning units were sorted according to similarities and differences and the analysis process was stored in NVivo 9 which provides an audit trail from the original interview text during every single step of the analysis to the themes [ 18 ]. Text units were step-vice grouped into categories of content and merged into higher abstraction level.
Finally, themes [ 15 ] and a main theme [ 19 ] were interpreted. To ensure trustworthiness in the analysis process the categories and themes were regularly compared with the original interview text and all authors took part in the process [ 15 ].
RESULTS During the analysis both explicit and implicit themes were identified [ 15 ] that reflect dimensions of relationship in home-based nursing care. Each sub-theme should be viewed as an interpretation of the content in part of the text. Metaphorically speaking the main theme is the warp that runs through the entire weave of content and the weft are sub-themes that represent different patterns in the weave [ 20 ]. The relationship seemed to be the vehicle through which the nurses could approach and reach the persons in need of care and was essential and a prerequisite for providing good nursing care.
Caring Relationships in Home-Based Nursing Care - Registered Nurses’ Experiences
Trust was an important component in a well-functioning relationship and could increase the sense of security, especially when the person was dependent on care. A trusting relationship could also contribute to make the person feel better. It seemed as the relationship in home-based nursing care was equally important regardless of which phase in life the person was in, palliative care or curative care.
Nurses described that home visits and the relationship seemed to be of more importance for lonely persons with limited supporting social network. Establishing the Relationship in Home-Based Nursing Care The relationship in home-based nursing care was established by the first encounter and the nurse and the person had contact with each other and from there built the relationship.
The first encounter and the first contact were characterized by normal socialization and were perceived as important, since it could affect the further development of the relationship between the nurse and the person. Nurses tried in the first contact to read the person and sense if the person was ready for further contact and a relationship with the nurse. When the first encounter and contact developed well, a good relaxed relationship could be built where the nurse and the person got to know each other.
Caring Relationships in Home-Based Nursing Care - Registered Nurses’ Experiences
Knowing each other also meant that the nurse still was professional but the conversation could be more personal without being private. The relationship was growing when nurses made home visits and gave support. The experience was that home visits could give a deeper and more intimate relationship than in hospital-based nursing care. Honesty Pharmacists are expected to act with honesty and integrity to maintain public trust in and uphold the reputation of the profession .
If patients feel pharmacists are being dishonest in any way, they are likely to lose their respect and credibility. Conducting the pharmacy business in an ethical manner is also important to build a trusting relationship by being open and honest in dealings with patients. For example, this may mean only conducting medicines use reviews MURs when there is a clear clinical need, despite the pressure of targets, or recommending the most appropriate non-prescription medicine product for the patient rather than the one with the greater profit margin.
Confidentiality Patients need to know that they can trust pharmacists and healthcare professionals to respect their privacy and dignity, otherwise this may prevent them from being able to ask for advice or share information.
If confidentiality of a patient is breached, it may not only harm the individual relationship with the patient, but also the trust that patient has built with any healthcare professional. Investing in the designation of a private space or room in your pharmacy is highly recommended to nurture public perception of the availability of privacy in community pharmacy. Confidentiality is a legal requirement, the principles of which are embedded in the GPhC standards with detailed guidance available separately .
It is important that staff are trained so that they are not only aware of the laws and regulations, but also of how they apply in day-to-day practice. There may be times when pharmacists and healthcare professionals are asked to disclose confidential patient information. In the first instance, patient consent to do so should be obtained. If this is not possible or would undermine the purpose of the disclosure, the pharmacist or healthcare professional needs to be satisfied that the disclosure is appropriate and meets any legal requirements surrounding confidentiality .
When unsure, further advice should be sought before divulging information. In addition, a full record of any requests or associated actions should be made; ultimately the pharmacist or healthcare professional must be able to justify any decisions and actions taken. Confidentiality in the pharmacy Do: Leave personal information lying around where it can be seen by others e. Showing respect and caring An important element of a lasting professional relationship is respect.
The GPhC standards state that cultural diversity and the right for patients to hold their own values and beliefs must be respected.
Pharmacists and healthcare professionals have an obligation not to allow any personal prejudices they may hold to detract from providing the highest quality patient care. Professional boundaries must also be maintained at all times; if these are crossed, patients may lose trust and confidence in pharmacists, healthcare professionals and the profession . Every patient deserves to be treated with dignity and respect, and by encouraging patients to deliberate and make choices through shared decision-making, patient autonomy is upheld .
Pharmacists and healthcare professionals have a moral obligation to build trust with patients and represent their profession in a trustworthy manner. It is important to remember that trust is a fragile concept; once interpersonal trust is lost, it can be difficult to rebuild . Under often difficult and stressful working conditions, pharmacists and healthcare professionals should strive to raise standards so that every opportunity to interact with, or on behalf of, patients helps towards building and maintaining trust.
Reading this article counts towards your CPD You can use the following forms to record your learning and action points from this article from Pharmaceutical Journal Publications.