Trust Development Between Patient and Nurse: A Grounded Theory Study

Trust is an important factor in the nurse-patient relationship and is part of collaboration in patient-centered care. Interpersonal trust between two people incorporates five key factors: risk, vulnerability, power imbalance, familiarity, and good will (Baier, 1986; De Raeve, 2002; Sellman, 2007). There has been limited research related to the development of trust in the nurse-patient relationship. In a research study related to trust development for the patient in the hospital setting, the researchers examined the patient-provider relationship including physicians and hospital staff but not exclusively the nurse-patient relationship (Hupcey, Penrod, & Morse, 2000). More recently, in a grounded theory study of the development of trust between the nurse and the hospitalized English-speaking Mexican-American patient in the USA, findings indicated that if the patient did not develop trust with the nurse, the patient may be less likely to ask questions or share personal information (Jones, 2015b). This reluctance to confide or share information was seen in previous studies related to culturally congruent care and Mexican American patients (Warda, 2000; Zoucha, 1998). In a follow-up study with Spanish-speaking Mexican American patients in the USA, the researcher again found trust was needed for the patient to be willing to share and, more importantly, the establishment of trust was evident even when a language barrier between the nurse and the patient was present (Jones, 2015a). In both these studies (Jones, 2015a, 2015b), trust with the Mexican American patient was examined because trust is an important Hispanic cultural value (National Alliance for Hispanic Health, 2001) and Hispanics in the USA report lower levels of trust compared to non-Hispanic white patients (Kaiser et al., 2011). However, trust may develop differently for non-Hispanic patients which led to the current study of how trust develops for the non-Hispanic patient in the USA.

Purpose:

The purpose of this study was to explain how does trust develops between the non-Hispanic English-speaking patient and the nurse in the hospital setting from the patient’s perspective.

 Methods:

Classic grounded theory (Glaser & Strauss, 1967) was used in this study since the goal is to explain a basic social process, trust. Inclusion criteria for the study were a) non-Hispanic, English-speaking adults, b) hospitalized at least 36 hours on medical-surgical or obstetrics unit, and c) anticipated discharge within the next few days. Patients were excluded if they were a) cognitively impaired (dementia, confusion) or b) admitted to a unit for treatment of a mental health condition. Participants were interviewed face to face in a private setting while hospitalized in the Midwestern United States. The researcher used a semi-structured interview guide and interviews were digitally recorded and transcribed verbatim. Data analysis was done concurrently with data collection using constant comparison, comparing incident to incident (Glaser, 2001). In data analysis, codes were generated from transcript review and then collapsed into categories forming a model of how trust develops and a core category emerged.

Results:

Findings from this study led to a model of the development of trust including outcomes presented as categories and the core category. Findings indicated that trust developed through the nurse’s initial approach toward the patient including the nurse’s attitude. Factors leading to trust included being genuine, being present, and talking personally. Interesting findings in this study were the development of a friendship-like bond between the nurse and the hospitalized patient. Another interesting finding was the vulnerability the patients felt when specific incidents led to trust development and participants referred to the nurse “saving the day”. This reflected the nurse acting on patient concerns rather than dismissing concerns. Outcomes of the development of trust included the patient confiding in the nurse, being willing to ask, and making the hospital stay easier.

 Conclusion: The development of trust is important for patients in the hospital setting and the nurse can do simple things which leads to trust such as talking personally and acknowledging patient concerns. Although this study was done in the USA with patients having unique cultural values, the model of how trust develops may be transferable to the nurse-patient relationship in other hospital settings throughout the world and have global implications. The findings are useful to promote the knowledge of how to develop trust with patients which may lead to improved individual patient outcomes and ultimately advance health. Findings from this study and previous studies will be used to build a middle range theory on the development of trust in the nurse-patient relationship with hospitalized patients.