Building Trust in the Nurse to Patient Relationship

By Carrie Mortrud, RN

Carrie Mortrud, RN

 

Year after year, the annual Gallup poll reports nurses are the most trusted profession. Nurses don’t take this for granted. We value this each and every year we receive the acknowledgement. What does it take, however, for a patient to trust his or her nurse completely?

 

My most influential trust experience as a bedside nurse occurred in my first six months as a nurse at a transitional care center. This patient was injured by a gunshot wound and was wheelchair bound. He likely suffered from depression being a young male in his 20s now facing a life without the ability to walk, run, and play ball as he once did. He spent many, many hours a day just lying in his bed refusing therapies, refusing rehab, and refusing care.

 

The patient also occasionally refused treatments delivered by staff he knew and always by any new staff. This was his choice but obviously it led to continued deterioration. He had the worst pressure ulcers or bedsores I had ever seen, and, in fact ,the worst I would ever see in my career. Many wounds were so deep, bone was exposed. There were 6-7 wounds we were required to change daily. We would have to remove old dressings or bandages and re-pack entire gauze packages in one wound. An entire ball of gauze fit in his wounds. Every night I attempted to convince him to let me change the dressings. Every night he refused and continued to refuse until someone he knew and trusted was assigned to him.

 

I did everything I was taught to try to build a relationship with this young man, but it took time. It took perseverance and a caring demeanor to break through. We quickly learned that, if he was approached in a rushed manor, he refused. If he felt we didn’t have time to care for him, he would just refuse to save us the time. I remember the sense of pride and empathy I had for him when he finally granted me access to his room to provide his cares to change his bandages to those bedsores.  I don’t know what happened to this young man who left such lasting impression on me. He taught me how valuable time with patients truly is.

 

In the hospital I was being rushed to provide care, rushed to provide discharge teaching, rushed educating patients and family members on procedures because staffing was so short on so many shifts. Day after day. Never enough time to administer the required amount teaching or compassionate care I knew they deserved and needed to heal.

 

In nursing school, training, and clinicals, the first skill of the first class the student nurse learns and practices is therapeutic communication. This provides a foundation of how to start a conversation with a stranger who the nurse is potentially going to be asking very personal questions and then providing hands-on care. All within minutes, the nurse tries to establish a rapport and sense of trust so that the experience can be the most beneficial and efficient for both the patient and the nurse. A nurse may have the patient in your care for days throughout their hospital stay or only minutes as they transfer from unit to unit. Regardless, their life is in our hands, and they must trust us.

 

As a patient’s length of stay continue to decrease, it is more critical than ever that nurses have the necessary time and resources to establish a trusting and meaningful relationship to better serve all patients in the healthcare system. Ensuring there are enough nurses assigned every day, every shift to patients in the hospital through establishing limits is the primary place to start.

Patient Story

arlene townsend staffing award

Unsafe staffing costs a Florida facility $1 billion

From Trial Magazine, March 2014 issue: Trial Magazine, 3/11/14 VERDICTS & SETTLEMENTS Arlene Townsend, 63 suffered a stroke and required 24-hour care. She was admitted to Auburndale Oaks Healthcare Center, a nursing home owned by Trans Healthcare, Inc. In the three years leading up to her death, Townsend suffered numerous fall resulting in broken bones and lacerations, infections, significant weight loss, chronic constipation, skin breakdowns, dehydration, and other problems. She is survived by her adult son. Townsend’s estate sued Trans Healthcare, alleging that it had understaffed the nursing home to increase profits and failed to provide adequate care, including protecting Townsend from falls, ensuring a safe environment, and documenting changes to her condition. The court entered a judgment of liability against the defendant, and the…
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