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Rushton 2007 article summary

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NUR1 221
Shari Gagne

Building Trustworthy Relationship With Critically Ill Patients and Families Rushton (2009) Summary: Using the case study of Mr. Nelson, a 59-year-old man on life support with little chance of survival and his families’subsequent relationship with the primary critical care team as an example, this study explores the defining attitudes & behaviors that contribute to Transactional Trust. Transactional Trust, based on the Reina Trust & Betrayal Model defines 3 types of trust: Competence Trust (Trust of Capability), Contractual Trust (Trust of Character), and Communication Trust (Trust of Disclosure). Efforts are made so that interactions between the concerned parties do not lead to feelings of betrayal and breach of trust. Trust - Defined as confidence in and reliance upon others, whether individuals, professionals, or organizations, to act in accord with accepted social, ethical, and legal norms - Trust & betrayal are 2 forces that affect the quality of relationships; they are fundamental to developing and maintain relationships, achieving outcomes and goals, and ensuring the integrity of individuals, processes, and structures - Trust is built through behavior and actions; it is built and earned incrementally - Capacity to trust is defined as a readiness & willingness to trust oneself & others and is influenced by perceptions, beliefs, and expectations - Capacity to trust is expanded by unguarded honesty, openness, and authenticity - Capacity to trust is restricted by betrayal which coexists with fear, anger, disengagement, disrespectfulness, or untrustworthy behavior; reaction to betrayal is often determined by past experiences AModel for Transactional Trust - Trust is transactional in that it exist between at least 2 parties, involves a mutual exchange, and is created incrementally over time; it is reciprocal & created incrementally Competence Trust (Trust of Capability) - Respecting the knowledge & wisdom of each person and their ability to make decisions, cope, carry out treatment plans, practice congruently with ethical norms, professional guidelines, etc. - Acknowledge people’s skills & abilities o Engage others to explore & understand implications of decisions to acknowledge their knowledge, skills, & abilities o Support strengths, explore fears, “hope for the best plan for the worst” - Allow people to make decisions & seek their input o Inquire how families can be helped and supported, the strengths that serve them in difficult times, and practices that support their well-being o Includes respecting & honoring decisions different from your own o Clinicians must work to remain present to families & their struggle - Help families & patients learn skills o Use of caring practices to lessen pain and suffering & offer family coping skills or alternative methods to problems o Focus on holistic interrelationships & broader needs of pt & family Contractual Trust (Trust of Character) - Based on the confidence that promises that are made will be kept; promises may concern expectations about outcomes, treatment processes, or potential complications to the boundaries and tenor of their relationships with healthcare professionals - Manage expectations o Make expectations explicit & clarity limits and boundaries of what can (and cannot) be done to treat the pt’s condition o Resist inclinations to offer s
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