Trust is a concept that is used by many disciplines, but not necessarily developed to the point where it is useful in advancing nursing science. Demonstrating the methods described in the second paper, this paper will present the steps used to advance the concept of trust to the point of clinical utilization through the development of a trust assessment guide.
This project began with a concept analysis of trust to determine level of concept maturity. From this investigation, concept advancement was undertaken addressing the gaps found per principle, the overall maturity of the concept, and the project goals. It was determined that trust needed to be investigated in two ways, using the literature as data and using the methods of grounded theory. A critical analysis of multidisciplinary literature from nursing, medicine, psychology, and sociology, was completed for the purposes of concept clarification. Through this investigation, a theoretical definition of trust and the conceptual components of the concept were posited. However, the concept’s usage within the context of health care would not be developed in this work. Thus, a grounded theory study was undertaken to examine trust in patients during an acute care hospitalization, for the purpose of concept development. From this study, a model of the process of developing and maintaining trust in health care relationships was developed. When both studies were completed, the finding were theoretically integrated resulting the advancement of the scientific concept toward maturity. However, there were areas of incongruence between the two studies. Additional studies were undertaken to address these incongruencies. A focus group study was done with community-dwelling elders and a grounded theory study was undertaken with parents of previously hospitalized children. Following these studies, template comparison was used to test the initial model against these the new models. This examination revealed areas requiring further investigation as the assessment criteria, intervention strategies, and evaluative components for a trust assessment guide, to be used by nurses, is being developed and tested.
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