Concept Analysis of Trust The concept of trust is integral to relationships both inside and outside of nursing. Because it is so essential to building positive connections, this analysis will be a deeper exploration of this concept to help understand how trust is a vital base on which many nursing theorists build their framework. Wea ver and Mitcham (2008) emphasize the importance of being able to categorize the content of nursing and recognize the need for unambiguous language in nursing knowledge. Concepts such as trust are significant to the discipline of nursing as they guide and link research with theory and practice. The importance of an analysis cannot be understated as it helps to clarify and objectify abstract term inology relating to the knowledge and science of nursing. By analyzing concepts, we are able to clarify defin itions and speak a more universal language which helps to more accurately connect knowledge and studies by their true commonalities. Definition and A ttributes The Macquarie Dictionary (2017) notes that the word trust originates from the Old Norse language meaning “shelter” or “protection” and defines it as (1) “reliance on integrity, justice, etc., of a person, or on some quality or attribute of thing; confidence,” and (2) “confident expectation of something; hope.” Trust is defined by The American Heritag e(R) Dictionary of the English Language (2016) as “ a firm belief in the integrity, ability, or character of a person or thing; confidence or reliance; the condition and resulting obligation of ha ving confidence placed in one. ” An entry in the Collins English Dictionary (2014) defines trust as “reliance on and confidence in the truth, worth, reliability, etc, of a person or thing; faith.” While the American Heritage Roget’s Thesaurus (2013) repeats the words “belief,” “confidence,” “faith,” and “relian ce ” which are also found in the definitions, it adds the word “dependence,” and the phrase CONCEPT ANALYSIS OF TRUST 3 “absolute certainty.” Frequently, trust is garnered between people in relationships with other people but the concept of trust can also refer to the confidence one has in his or her environment or in a certain situation. The defining attributes of trust include faith, c onfidence, reliance , and vulnerability. Faith is, according to The Macquarie Dictionary (2017 ), “confidence or trust in a person or thing,” and a “belief which is not based on proof,” and is a construct of primary trust. In many relationships, trust is earned and de veloped over time. In nursing, however, the development of trust is an accelerated process. Akin to the primary trust that an infant has in his or he r caretaker, many patients trust their nurses without taking time to build a n interpersonal relationship ( Rutherford , 2014 ) . To start and maintain a relationship of this primary trust , the patient places a level of faith in the nurse’s rel iability, knowledge, experience, and a desire to help increase the patient’s wellness ( Ozaras & Abaan , 2018 ). Similar to faith, confidence is defined by The American Heritage(R) Dictionary of the English Language (2016) as “the belief in the certainty of something. ” Unlike faith, confidence can be the result of a proven history of the meeting of one’s expectations. Confidence can grow due to the patient’s past experiences or can be the result of the reputation of the professional discipline. Vulnerabili ty is a unique aspect to trust as it denotes a susceptibility to eithe r physical or emotional injury ( V ulnerable, 2016). In nursing, trust is established in patients who present with needs that are either emotional or physical in nature. T he reliance the patient places on a nurse is vulnerable in nature and if the relationship proves untrustworthy, his or her needs may go unmet. Because nurses have a specialized knowledge base, the patient may feel as though there is an imbalance in the relationship, aff ecting both vulnerability and trust either positively or negatively at times ( Ozaras & Abaan, 2018). CONCEPT ANALYSIS OF TRUST 4 Model Case A model case, which includes all the attributes of trust, is represented in the case of a patient who entered the Ambulatory Surgery department for a minor procedure. She was visibly trembling and verbally repeated that prior to her last surgery, seventeen attempts were made to secure an intravenous access. To develop trust with the patient, her nurse listened c arefully to her concerns. Upon assessment, it was noted that the patient had not taken her anti – anxiety medication that morning. The intravenous catheter was inserted skillfully afte r a numbing agent was applied. Once in place, a dose of the patient’s t ypical anti – anxiety medication was given. In this case, the nurse’s full assessment, willingness to listen to the patient’s concerns, competent skill level, and communication with the physician for orders fostered the attributes of faith, confidence, reli ance , and vulnerability . The patient responded to her needs being met with positive interactions as trust was established. Contrary Case A contrary case contains no attributes of the concept and will serve as a clear example of a lack of trust. The patient in this case has a history of a myocardial infarct ion five years ago and lost his wife nine months ago. He has a pending medical malpractice lawsuit against her physician for her death . More recently, he began forgetting to take his daily m edications and he was referred to cardiac r ehabilitation after needing one stent placed in his right coronary artery . Upon assessment, he states, “ What do you mean I’ll have to come three times a week? There is nothing you people can do to help me. I’m n ot sure if I will even show up for these sessions. They seem like a such a waste of my time. The only thing you medical people ever want from me is my money anyway.” The nurse listened to his concerns and explain ed the benefits of the program but the pa tient remained adamant that no one had his best interest at heart. The patient CONCEPT ANALYSIS OF TRUST 5 left the department without finishing the assessment. In this case, the patient’s trust was eroded by the circumstances of his wife’s death. He was unable, then, to trust his own care to anyone else. He had no faith, confidence, or reliance in the nurse. He w as unable to open himself up or to be vulnerable. Borderline Case A borderline case has some attributes of a concept but does not qualify as con taining all of them; it may only partially represent trust. In this case, the patient has been attending cardiopulmonary rehabilitation three times a week consistently for nine months. She has developed personal relationships with the full – time nurses and shares stories about her adult children. One adult child is ill at the time of this case and the patient casually relays sensitive medical information about her child to the nurse while other staff is standing at the desk. Because the patient has put her trust into the nurse for her own care, she seems comfortable sharing this information with other staff present as well. While the attributes of trust are fully present in the nurse – patient relationship, only faith would be present in the relationship with the other staff. T here is no evidence of confidence, reliability, or vulnerability. Invented Case In this invented case, the patient is pediatric and the family is viewed as being an integral part of the patient’s care plan . This five – year – old pat ient had been ill with chr onic tonsillitis for six months and his tonsils and adenoids were removed four days ago . Due to the extreme enlargement of his tonsils during the illness , he was unable to sleep well and his mother states that she has not had a full night’s sleep in months. In this case, he presents to the Emergency Department with dehydration and bloody emesis. The patient’s mother has dark circles under her eyes and is tearful. She states that the last four days of his recovery have been extremely CONCEPT ANALYSIS OF TRUST 6 difficult and neither she nor the patient have been eating or sleeping. The patient is taken to a surgical suite for an emergency cauterization and then to an inpatient room for overnight observation. The patient’s nurse rounds on the patient throughout the night, assesses breathing, intakes, and provides pain medications as needed. The patient’s mother sleeps. She awakes in the morning during the physician’s assessment , t hanks the nurse, and says that she was finally able to sleep for the first time in months. In this case, the patient’s mother exhibits faith, confidence, reliance, and vulnerability as she puts her trust in the nurse and is able to then care for her own s elf. Related C oncepts and I naccuracies Related to trust are the concepts of hope, conviction, and dependence. These terms are closely connected to the concept of trust but are not defining attributes of it. Because hope is a term that refers to the future, what one hopes for may change due to his or her circumstances . It is a belief in what could happen but requ ires no reliance or faith that it will happen. Conviction is a “fixed or strong belief ” (Conviction, 2016) but may not be based on reliance or faith. In a dependent situation, one relies on another for the meeting of his or her needs but may or may not be faithful or confident that those needs will actually be met. An inaccurate use of the concept of trust would be in certain over – crowded foreign orphanage s. Babies in these environment s have their nutritional and elimination needs met but experience neglect on almost every other level of need. While one may deduct that the infant trusts his or her caregiver to meet nutritional needs, this is not true as many are conditioned to the environment and operate on an innate response to food. Res earch has found that the inability to rely on adult caregivers even alters the brain patterns (Pappas, 2012). This negative outcome combined with the absence of faith, reliability, CONCEPT ANALYSIS OF TRUST 7 and confidence are clear indicators that trust was never actually establis hed even though certain needs were met.