Creating trust in an acute psychiatric ward

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as ;fragile' phenomena that can easily ;tip over' towards their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses.     

Impersonal trust and professional authority: exploring the dynamics

AIM: The aim of the study was to explore the relationship between impersonal trust, governmentality and professional activity through an analysis of professional discourse. BACKGROUND: This study emerged from an earlier paper that described a four-dimensional model based on Luhmann's definition of trust as "reducing complexity and managing expectations". Linking trust with the Foucauldian notion of governmentality develops this further. Governmentality raises the question of how professional authority is constituted through the practice of nurses and other health and welfare professionals. METHOD: Discourse analysis was used to explore the text from two genres--academic literature and interview material (n = 17)--in the context of community residential services for people with learning disabilities. Findings. The study provided evidence to support claims that trust is produced through impersonal systems. Trust is contested in a dynamic process where there are gains and losses. Professionals in organisations actively promote trust, often through systems of distrust. The study also built on the four-dimensional model of impersonal trust--trust, mistrust, abuse and hope--and re-conceptualized the trust-hope dimension. CONCLUSION: There are theoretical links between governmentality and trust. Similarly, in order to understand trust nurses need to understand the dynamic nature of the systems in which they operate. The proposition that trust could frustrate hope adds an element of controversy to the discussion of hope in the nursing literature.     

Trust and managerialism: exploring discourses of care

AIM: This paper reports a study that explored the relationship between trust and managerialism through an analysis of professional discourse. BACKGROUND: Managerialism is a distinct set of discourses and practices related to managerial effectiveness, flexibility and consumer responsiveness that have come to characterize debates over the provision of health and welfare services across the developed world. At the same time, trust has attracted increasing academic and political interest. Managerial discourses are critical of healthcare professions and the way they operate. Professional opinions are challenged as representing the interests of professions rather than service users; as a consequence trust is contested. However, where practitioners are both professionals and managers, the boundaries between these discourses become blurred. Moreover, paradoxical development occurs where increasing autonomy for practitioners is accompanied by a strengthening of managerial controls over their activity. METHOD: Discourse analysis was used to explore the text from two genres, academic literature and interviews (n = 17), in the context of community residential services for people with learning disabilities. The study was conducted in 2001. FINDINGS: Two broad themes were identified, each with a number of sub-themes. The first focuses on the relationship between managerialism and trust located around the management of expectations. The second, 'the politics of care', explores the way professional and managerial discourse articulate to produce complementary and contradictory positions. CONCLUSION: The colonization of professional activity by managerial discourse has produced a context where professional activity is defined by a series of managerial imperatives; trust, which was once the product of intimate social activity is now shaped through techniques based on distrust such as audits and quality monitoring. Nevertheless, the persistence of tensions between trust and managerialism suggest an ongoing struggle for professional autonomy in the face of increasing managerial controls.     

Unrelieved pain: an ethical and epistemological analysis of distrust in patients.

Unrelieved pain is a serious clinical problem that has received little attention in bioethics. This paper contends that unrelieved pain is the result of distrust in patients that reveals both an ethical and epistemological failure on behalf of nurses and physicians. The analysis is conceptually framed in previous work on the articulation of trust in nursing. Specifically, an argument is made that clinicians do not trust patients' subjective experiences, distrust patients from marginalized and relatively less powerful groups, and resist entrusting themselves or becoming vulnerable to patients' pain and suffering. The authors discuss the need for awareness and critical examination of deeply entrenched societal beliefs and values that influence everyday decision-making in pain management.     

Crises of trust

Extensive media coverage is warning of a crisis of trust that has emerged as a serious issue in our society. This article explores the meaning of "crisis," concepts of crisis management, mechanisms for building trust, and the underlying significance of trust and distrust. Evidence is adduced to testify to the erosion of trust and factors in our society that reflect the potential for crises of trust. Organizational decision makers, including hospital managers, are urged to identify and reflect upon weaknesses in their organizations in order that remedial action can be taken to preempt such crises.     

The transparent organization: leadership in an open organization.

The impersonal approach to health care leadership is over. Specialization, hierarchies, and impersonal decisions have led the public to distrust health care organizations. The charges of unnecessary cardiac surgery and abuses led the public to question our integrity. Annison and Wilford (1998) note that the character of a person and the character of an organization lead one to trust or distrust. They note that openness is one of the most important characteristics upon which we judge the character of a person or an organization. As the operating framework of partnerships and transparency becomes one that our staff and patients expect, our ability to handle openness will be an important way in which we are judged.     

The transparent organization: leadership in an open organization

The impersonal approach to health care leadership is over. Specialization, hierarchies, and impersonal decisions have led the public to distrust health care organizations. The charges of unnecessary cardiac surgery and abuses led the public to question our integrity. Annison and Wilford (1998) note that the character of a person and the character of an organization lead one to trust or distrust. They note that openness is one of the most important characteristics upon which we judge the character of a person or an organization. As the operating framework of partnerships and transparency becomes one that our staff and patients expect, our ability to handle openness will be an important way in which we are judged.     

精神病患者人际信任与社会支持相关性研究

目的探讨精神疾病患者人际信任与社会支持的相关性。方法采用描述性相关研究,分别用人际信任量表和社会支持量表,对218例精神疾病患者进行问卷调查,同时对结果进行统计学分析。结果精神疾病患者人际信任状况总体得分偏低,人际信任度低;社会支持总体得分处于较低支持水平,社会支持对人际信任有一定影响,人际信任与社会支持呈正相关(γ=0.28,P<0.001)。结论社会支持系统会影响患者的人际信任度,护理人员合理地为患者建立完整的社会支持系统,能提升患者的人际信任度,从而降低患者对医护治疗护理的不信任。     

Adolescents with inflammatory bowel disease feel ambivalent towards their parents' concern for them

This is a grounded theory study to identify concepts for describing how adolescents with inflammatory bowel disease (IBD) respond to their parents' concern for them. Ten adolescent boys and seven girls were interviewed. In the analysis four main categories emerged: ambivalence, ability/inability, compliance/resistance and trust/distrust. We found ambivalence to be the most distinctive theme to appear in the way in which these young people described how they felt about their parents' response to their disease. The core category ambivalence was expressed as an oscillation between seeking close contact with one's parents or, sometimes, staving them off, one moment feeling anxiously dependent upon them or turning to them for protection and support and the next, trying to achieve a dialogue with them. The core category comprised three subcategories, ability/inability, compliance/resistance and trust/distrust. The clinical support for young individuals with IBD should include an awareness of the simultaneous existence of conflicting attitudes, reactions and emotions.     

Health-care system distrust in the intensive care unit

Purpose

To examine the performance and properties of the Revised Health Care System Distrust Scale among surrogates in the intensive care unit (ICU).

Materials and Methods

Pilot, prospective cohort study of 50 surrogates of adult, mechanically ventilated patients surveyed on days 1, 3, and 7 of ICU admission.

Results

Responses on the Health Care System Distrust Scale on day 1 ranged from 9 to 34 (possible range 9-45, with higher scores indicating more distrust), with a mean and SD of 20.3 ± 6.9. Factor analysis demonstrated a 2-factor structure, corresponding to the domains of values and competence. Cronbach α for the overall scale was .83, for the competence subscale, .76, and for the values subscale, .74. Health-care system distrust was inversely correlated with trust in ICU physicians (Pearson coefficient −.63). When evaluated over the course of each patient's ICU stay, health-care system distrust ratings decreased by 0.31 per patient-day (95% CI 0.55-0.06, P = .015). Correlation between health-care system distrust and trust in ICU physicians decreased slightly over time.

Conclusions

Among surrogates in the ICU, the Health Care System Distrust Scale has high internal consistency and convergent validity. There was substantial variability in surrogates' trust in the health-care system.     

医疗纠纷与信任危机

分析医疗纠纷形成的过程及医护人员的行为中易造成患者不信任的各种因素,认为信任危机是医疗纠纷的根本原因。探讨了减少和防范医疗纠纷、构建良好医患信任关系的方法。     

Establishing and maintaining trust during acute care hospitalizations

The concept of trust is significant in nursing; however, it remains inadequately defined and operationalized. The purpose of this study was to advance the development of the concept of trust by exploring patients' perspectives of processes of establishing and maintaining trust in health care providers during acute care hospitalizations. Grounded theory methods, including theoretical sampling and the constant comparative processes, were used. The sample included 50 adult inpatients with a wide variety of medical-surgical diagnoses who discussed their experiences while hospitalized. The core variable linking the process of developing and maintaining trust was meeting expectations. Through a series of interactions with health care providers and other hospital personnel, patients used monitoring behaviors to evaluate congruency between their expectations of care and the actual behaviors of providers. From this evaluation, three trajectories were identified based on whether expectations were met, exceeded, or unmet. Trust was shown to be dynamic and thus permits opportunities for interventions to redirect the trajectory.     

The Development of Trust in Parents of Hospitalized Children

ISSUES AND PURPOSE The purpose of this study was to investigate the development of trust in parents of hospitalized children. METHODS Using grounded theory, semistructured interviews were conducted with 15 parents of children previously hospitalized, focusing on parents' experiences during their child's hospitalization. Data were analyzed using a constant comparative process. Themes and the core variable were identified and a model of trust developed. RESULTS The core variable related to the development of trust in healthcare providers was whether parents' expectations for care were met. Thematic areas that influenced whether expectations for care were met included preexisting trust; evaluation of care, including evaluation of technical skills and the meeting of parental and child needs; and behaviors of nurses and other healthcare providers that inhibited and fostered trust. PRACTICE IMPLICATIONS Strategies to enhance trust are discussed.     

Ethnography and the generation of trust in breastfeeding disparities research

There are persistent racial/ethnic disparities in breastfeeding rates in the United States, and research is needed to examine underlying psychosocial, economic, and cultural factors. Research into health disparities is impeded by problems of distrust. This methods-focused article describes how an ethnographic approach can be used to generate trust while obtaining contextually detailed data. Examples are provided from an ethnography of infant feeding decisions among low-income, Black women. Trust-generating strategies included respectful entry into the field, recognizing and decreasing differences in power, sensitivity to time and timing, and a relational approach.     

Expectations for care: older adults' satisfaction with and trust in health care providers

This study sought to determine whether community-dwelling older adults' expectations for care were met by identifying factors that influence trust in and satisfaction with health care providers. Data were collected using a demographic questionnaire and focus group methodology. A total of 39 older adults participated in 8 focus groups. Three categories of themes were identified: a sense of personal touch, technical proficiency, and environmental factors. These categories related to individual providers or practice environments. When providers and practice settings met expectations for care, then the elderly individual was satisfied. Trust was more complex, as the older adults indicated they could be satisfied but not trust providers or they could trust providers but not be satisfied. Implications for practice include spending quality time with older adults and treating them as individuals.     

Building trustworthy relationships with critically ill patients and families

A difficult case study involving repeated health crises and irreversible organ dysfunction illustrates the challenges critical care professionals face in caring for patients and their families. In such cases, trust is especially fragile, and coexists with its counterpart, betrayal. The Reina Trust & Betrayal Model defines 3 types of Transactional Trust. The first, Competence Trust, or the Trust of Capability, requires that clinicians practice humility, engage in inquiry, honor the patient's choices, and express compassion. The second, Contractual Trust, or the Trust of Character, demands that clinicians keep agreements, manage expectations, establish boundaries, and encourage mutually serving expectations. The third, Communication Trust, or the Trust of Disclosure, must be rooted in respect and based on truth-telling. Particularly in life-and-death situations, communication requires honesty and clarity. Each type of trust involves specific behaviors that build trust and can guide critical care professionals as they interact with patients and their families.     

Components of social capital and socio-psychological factors that worsen the perceived health of Japanese males and females

Social capital refers to the quantity and quality of social relationships, such as formal and informal social connections as well as norms of reciprocity and trust that exist in a place or a community. This article analyzed the data from Japan 2004 B Survey in order to elucidate the effects of social capital and socio-psychological factors on the health of Japanese males and females. The Survey was a part of a nationwide random study on Japanese national character, which has been conducted by the Institute of Statistical Mathematics since 1953. A total of 785 (372 males and 413 females) valid data from 1,200 adult samples were used. Logistic regression analysis showed that the self-reported symptoms were increased by negative attitude to generalized trust in males, and by negative attitude to norm of reciprocity in females. Moreover, in females, health dissatisfaction was enhanced by low perceptions of support. In both genders, self-reported symptoms and health dissatisfaction were worsened by anxiety. The self-reported symptoms were increased by an adherence to religion and spirituality in males, whereas in females, the health dissatisfaction increased with low income and a concern about superstitions. Thus, from a viewpoint of social capital, perceived health is susceptible to personal relationships in females and to distrust in males. Anxiety seems a key factor affecting perceived health. In addition, females are influenced by economic status and superstitions, whereas males are more concerned about religion or the mind in relation to health. These findings are useful in developing health policies for Japanese.     

Cultural factors in preventive care: African-Americans

In summary, the implications for healthcare practitioners in caring for African American patients in a culturally sensitive manner include: Gaining trust, and understanding the historical distrust of the health care system Understanding and employing the kinship web in decisions regarding screening and treatment Involving the church in developing and delivering prevention and care messages Asking patients about the meaning of words or phrases Asking patients about the use of alternative medicines and herbs Tailoring messages about prevention to depictions of real life situations Paying attention to body language and other nonverbal communication.     

Brain mapping of psychological processes with psychometric scales: An fMRI method for social neuroscience

IntroductionThe functional neuroimaging literature has used many stimuli (e.g., games, pictures, sounds) in fMRI studies to induce activation in brain areas related to psychological processes. To improve the link among psychological processes and their brain mapping, this study integrates the theory of measurement in the social sciences with the functional neuroimaging literature to propose a simple method that localizes the neural correlates of psychological processes using psychometric scales as stimuli to induce brain activation.Materials and methodsTwo fMRI studies were performed to illustrate this method with 30 subjects who responded to psychometric scales for four psychological processes on 7-point Likert-type anchors while their brains were being scanned in an fMRI. The first study examined two psychological processes–trust and distrust–whose neural correlates are known. The second study examined two psychological processes specific to technology use context–perceived usefulness and perceived ease of use–whose neural correlates are still unknown.ResultsResults from the first fMRI study confirmed the neural correlates of trust in the caudate nucleus, putamen, anterior paracingulate cortex, and orbitofrontal cortex and of distrust in the amygdala and insular cortex, thus confirming the literature. The second fMRI study identified the neural correlates of perceived usefulness in the anterior cingulate cortex, caudate nucleus, and insular cortex and perceived ease of use in the dorsolateral prefrontal cortex, which are consistent with the technology use literature.DiscussionThe proposed brain mapping method with psychometric scales can inform the neurological nature of psychological processes, challenge existing measurement assumptions, and help advance brain mapping.