The antecedents, attributes and consequences of trust among nurses and nurse managers: A concept analysis

A Concept Analysis of Trust Within the Surrogate Decision Maker to Health Care Professional Relationship in the Adult ICU Setting

Surrogate decision maker (SDM)-health care professional (HCP) trust is vital to the provision of high-quality care in the adult intensive care unit setting. This concept analysis, using Walker and Avant's methodology, examines the concept of SDM-HCP trust and provides a conceptual definition conducive to instrument development and future quantitative research into this topic. Trust in the SDM-HCP relationship exists on a spectrum and involves the voluntary placement of oneself into a position of vulnerability in relation to another party who is believed to have integrity, be reliable, and hold beneficent intent toward the truster.

Nurses' Perception of Professionalism in Practice: A Review of Qualitative Studies

Professionalism is a fundamental concept in nursing and a central aspect of nursing care. The review aimed to synthesize evidence presented in qualitative studies related to the perception of professionalism in nursing practice. Six main analytical themes were generated from primary studies included in the literature review: everyday practice, ethical aspects of nursing care, nurses' identity, nurses' professional growth, achieving autonomy, complexity of relationships. Presented themes are considered key elements of nursing professionalism, are closely interconnected, and support the multidimensional structure of professionalism in nursing. Nursing professionalism means providing high-quality care while upholding the values of integrity, accountability, and respect.

Trustworthy management in hospital settings: a systematic review

BACKGROUND

Trustful relationships play a vital role in successful organisations and well-functioning hospitals. While the trust relationship between patients and providers has been widely studied, trust relations between healthcare professionals and their supervisors have not been emphasised. A systematic literature review was conducted to map and provide an overview of the characteristics of trustworthy management in a hospital setting.

METHODS

We searched Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link from database inception up until Aug 9, 2021. Empirical studies written in English undertaken in a hospital or similar setting and addressed trust relationships between healthcare professionals and their supervisors were included, without date restrictions. Records were independently screened for eligibility by two researchers. One researcher extracted the data and another one checked the correctness. A narrative approach, which involves textual and tabular summaries of findings, was undertaken in synthesising and analysing the data. Risk of bias was assessed independently by two researchers using two critical appraisal tools. Most of the included studies were assessed as acceptable, with some associated risk of bias.

RESULTS

Of 7414 records identified, 18 were included. 12 were quantitative papers and 6 were qualitative. The findings were conceptualised in two categories that were associated with trust in management, namely leadership behaviours and organisational factors. Most studies (n = 15) explored the former, while the rest (n = 3) additionally explored the latter. Leadership behaviours most commonly associated with employee's trust in their supervisors include (a) different facets of ethical leadership, such as integrity, moral leadership and fairness; (b) caring for employee's well-being conceptualised as benevolence, supportiveness and showing concern and (c) the manager's availability measured as being accessible and approachable. Additionally, four studies found that leaders' competence were related to perceptions of trust. Empowering work environments were most commonly associated with trust in management.

CONCLUSIONS

Ethical leadership, caring for employees' well-being, manager's availability, competence and an empowering work environment are characteristics associated with trustworthy management. Future research could explore the interplay between leadership behaviours and organisational factors in eliciting trust in management.

Cultural Adaptation and Psychometric Properties of the Trust Me Scale-Italian Version: A Validation Study

BACKGROUND

The Trust Me Scale is a widely used instrument to measure trust in healthcare providers. However, no Italian version of the scale exists yet, limiting its use in Italian-speaking populations. The aim of this study is to translate and validate the Trust Me Scale for use in Italian-speaking populations in nurses and nurse managers.

METHODS

The translation process involved methodological steps of collaborative and iterative translation with cultural adaptation. The validation process included a cross-sectional study enrolling a convenience sample of 683 nurses and 188 nurse managers who completed the Italian version of the Trust Me Scale and measures of intention to leave, satisfaction, and organizational commitment.

RESULTS

Item 5 was removed for poor factor loading, and items 11 and 13 were removed following an a priori strategy focused on deleting items with correlations between residual variables different than expected based on theoretical expectations derived from previous research. The final model fit well to sample statistics with a three-factor structure (harmony, reliability, and concern) and 13 items. A multiple-indicator multiple-cause model showed a measurement invariance between nurses and nurse coordinators. Construct validity was also supported by the evidence that the measured domains of trust align with the theoretical expectations and are related to the intention to leave, job satisfaction, and organizational commitment. Each dimension showed adequate scale reliability.

CONCLUSIONS

The Italian version of the Trust Me Scale is a valid and reliable instrument to measure trust in nurses and nurse managers in Italian-speaking contexts. It can be used for research in nursing and leadership and evaluation of interventions aimed at improving trust in healthcare contexts.

Trust as a mediator of the relationship between human resource development climate and organisational citizenship behaviours

Purpose

The purpose of this research is to address the importance of human resource development (HRD) and its resultant climate in an organization. Specifically, the study examines the cause-effect relationship between HRD climate and organisational citizenship behaviour (OCB), as well as the role of organisational trust in this relationship. The study is underpinned by the social exchange theory.

Design/methodology/approach

The study adopted the quantitative research approach and the cross-sectional survey design in data collection. Two hundred seventy-four employees were sampled from the food manufacturing sector, out of which 219 responded. Data was entered using SPSS v.23 and analysed with Pearson’s Product correlation, hierarchical regression analysis and independent t-test. The mediation effect was analysed using Process Macro v 3.5 for SPSS.

Findings

Results indicate that HRD climate has a positive effect on OCB, hence, a predictor. Also, HRD climate was observed to be a predictor of organisational trust and that organisational trust mediates the cause and effect relationship between HRD climate and OCB. This study recommends that management continues to invest in the development of employees as it goes a long way to ensure the survival and growth of the organisation.

Originality/value

To the best of the authors’ knowledge, this study is the first of its kind to examine the interplay between HRD climate, trust and OCBs.

Managing in Critical Care Settings: A Qualitative Study of South African Nurse Unit Managers and the Psychological Contract

Introduction

Little is written about the management of psychological contracts by nurse unit managers (NUMs) in critical care settings and how this perspective contributes to the performance, experiences, and views of nurses and nursing teams. Psychological contracts are important regulators of the employer-employee relationship, with managers (NUMs) being the embodiment of the employer in managing the contract.

Objectives

This qualitative study answers a call for research on the NUM perspective of the psychological contract given the role they play in the wellbeing of critical care nurses and quality of care provided. The study aims to understand the expectations and obligations that constitute the psychological contract NUMs have with their nursing teams, the nature of the contract, and how NUMs practically manage these aspects on their teams.

Methods

Using an interpretive qualitative research design and a purposive sampling technique, semi-structured interviews were conducted with 10 of the 14 NUMs from a public health facility about critical incidents relating to their obligations and expectations of managing critical care nurses.

Results

A thematic analysis of their responses revealed five main themes that represent the contents of their psychological contracts with critical care nurses: professional commitment and obligation; leading by example; trust and support; teamwork; and on-the-job training and further development. In their discussion of these components, the NUMs also revealed how they manage the psychological contract with nurses.

Conclusion

Based on the expectations and obligations NUMs hold with their staff, their psychological contracts were found to be largely relational, with elements of the balanced type, suggesting that they rely on interpersonal connection and coordination, as well as knowledge dissemination, to uphold the contract. This contract appears to be effective in inculcating the commitment of nurses to their profession and professional standards through the building of trust and offering of support. However, recommendations are offered to ensure NUMs are best prepared to sustain these psychological contracts and continue to support nurse wellbeing and related patient care.

Best practice recommendations for healthy work environments for nurses: An integrative literature review

Healthy work environments that maximise the health and well-being of nurses are essential in achieving good patient and societal outcomes, as well as optimal organisational performance. While studies have been conducted on healthy work environments, there is no available evidence that an integrative literature review summarising best-practice recommendations related to healthy work environments has been conducted before. This review aimed to summarise existing best-practice recommendations related to a healthy work environment for nurses. An integrative literature review following the approach adapted from Whittemore and Knafl was used. Existing guidelines related to healthy work environments for nurses were searched. EBSCOhost (CINAHL, Medline), Biomed Central, Science Direct, PubMed and Google Scholar and organisational websites via Google were searched, followed by a citation search. Twelve guidelines were identified for data extraction and synthesis, and themes were subsequently formulated. Four themes emerged from the integrative literature review regarding a healthy work environment for nurses: (1) the need for effective nursing leadership, (2) effective communication as central to enhancement of a healthy environment, (3) effective teamwork as an integral part of a healthy work environment and (4) the need for professional autonomy. In summary, a healthy work environment for nurses requires leadership, effective communication, teamwork and professional autonomy.

Concept Inventing: Feeling Trusted

With the humanbecoming concept inventing model, the scholar conceptualized a novel idea about the universal humanuniverse living experience of feeling trusted. The now-truth of feeling trusted is cherished acknowledgment with sureness-unsureness arising with gracious alliances. The ingenuous proclamation of feeling trusted as a theoretical statement is valuing the originating of connecting-separating and as an artform is the film of The King's Speech. The conceptualization of feeing trusted using the humanbecoming concept inventing model contributes to the advancement of nursing knowledge of universal humanuniverse living experiences.

Parents' experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (the DETECT study): A qualitative interview study

BACKGROUND

Failure to recognize and respond to clinical deterioration in a timely and effective manner is an urgent safety concern, driving the need for early identification systems to be embedded in the care of children in hospital. Pediatric early warning systems (PEWS) or PEW scores alert health professionals (HPs) to signs of deterioration, trigger a review and escalate care as needed. PEW scoring allows HPs to record a child's vital signs and other key data including parent concern.

AIM

This study aimed to explore the experiences and perceptions of parents about the acceptability of a newly implemented electronic surveillance system (the DETECT surveillance system), and factors that influenced acceptability and their awareness around signs of clinical deterioration and raising concern.

METHODS

Descriptive, qualitative semi-structured telephone interviews were undertaken with parents of children who had experienced a critical deterioration event (CDE) (n = 19) and parents of those who had not experienced a CDE (non-CDE parents) (n = 17). Data were collected between February 2020 and February 2021.

RESULTS

Qualitative data were analyzed using generic thematic analysis. Analysis revealed an overarching theme of trust as a key factor that underpinned all aspects of children's vital signs being recorded and monitored. The main themes reflect three domains of parents' trust: trust in themselves, trust in the HPs, and trust in the technology.

CONCLUSION

Parents' experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (The DETECT system) were positive; they found it acceptable and welcomed the use of new technology to support the care of their child.

The effect of felt trust from patients among nurses on attitudes towards nursing service delivery

AIMS

To examine how felt trust motivates nurses to desire to deliver better nursing services and how perspective taking makes nurses feel trusted by their patients. By introducing the concept of prosocial motivation into nursing research, this study further explored a boundary condition that influences the positive relationship between felt trust from patients and attitudes towards nursing service delivery.

DESIGN

This study used a cross-sectional and survey design.

METHOD

This study was conducted among 339 nurses on medical teams sent to support Hubei, China, during the COVID-19 pandemic in April 2020.

RESULTS

The results indicate that felt trust from patients mediated the positive relationship between perspective taking and attitudes towards nursing service delivery. In addition, prosocial motivation moderated the relationship between felt trust from patients and attitudes towards nursing service delivery, such that the relationship was stronger when prosocial motivation was high (vs. low). Prosocial motivation also moderated the indirect effects of perspective taking on attitudes towards nursing service delivery via felt trust from patients.

CONCLUSION

This study shows that despite the challenges posed by COVID-19, nurses who experience a high level of trust from patients are still eager to deliver high-quality nursing services, and this finding is especially salient among those with high prosocial motivation.

IMPACT

This study introduces felt trust from patients as a new motivational mechanism that can induce nurses' willingness to deliver better nursing services. We suggest that nurses and nurse leaders should be aware of the significance of the trust relationship between nurses and patients. Nurses need to be trained to take patients' perspectives in the interaction process, which can make them feel trusted by patients and can consequently be motivated to deliver better nursing services.

Trust initiation and development in SME-university collaborations: implications for enabling engaged scholarship

Purpose

The purpose of this study is to explore trust initiation and development in collaborations between universities and small- and medium-sized enterprises (SMEs) and the implications for enabling engaged scholarship (ES).

Design/methodology/approach

Adopting a qualitative inductive approach, semi-structured interviews were conducted with a purposive maximum variation sample comprising 14 SMEs and 12 university stakeholders.

Findings

The authors highlight the role of calculus-based trust in the initiation of collaborations emphasising the key roles of networking and referrals. As collaborations develop, reciprocal insights regarding stakeholders’ competencies and integrity and the development of knowledge-based trust can support engagement, in particular, knowledge application. Although relationships have a common sense of purpose, a fully engaged campus remains absent.

Research limitations/implications

This study is based on a collaborative research between eight SMEs and one university business school and does not reflect ES fully as conceptualised. It provides few insights into the role of trust (or distrust) in such collaborations where things go wrong.

Practical implications

Universities looking to enable ES collaborations with SMEs need to develop and enact strategies which support ongoing engagement and enable identification-based trust (IBT). Recommendations for universities and human resource development regarding interventions to support trust initiation and development to enable knowledge application ES are outlined and suggestions are offered for future research.

Social implications

University strategies to support the development of trust and, in particular, IBT are likely to benefit longer-term relationships and the development of ES between SMEs and universities.

Originality/value

Little research has been undertaken on trust initiation and development between academic and SME stakeholders or the associated implications for ES.

Experiences With Managing the Workplace Social Environment: A Qualitative Study

OBJECTIVE

This study aims to examine 1st-line managers' (FLMs') experiences in managing the workplace social environment (WSE).

BACKGROUND

FLMs are responsible for the establishment and maintenance of supportive WSE essential for effective teamwork. Poorly managed WSE and dysfunctional teams hold negative implications for patients, teams, and organizations.

METHODS

This was a qualitative descriptive study, using content analysis of individual and focus group interviews with FLMs and directors.

RESULTS

FLMs play a critical role in the management of the WSE; however, the task is fraught with constraints and challenges including competing demands, lack of support, and insufficient training. Findings explicate how competing demands and communication challenges impede the successful management of the WSE.

CONCLUSIONS

Given the importance of a healthy WSE to patient, professional, and organizational outcomes, FLMs need support, training, and resources to assist them in managing the social environment alongside other competing priorities.

Intensive care nurses in South Africa: Expectations and experiences in a public sector hospital

AIM

To explore the content, fulfilment and potential breach of nurses' psychological contracts and provide a nuanced understanding of the expectations and lived experiences of intensive care unit (ICU) nurses.

BACKGROUND

The challenges presented by the South African healthcare system have implications for the motivation and retention levels of ICU nurses. In an environment such as the ICU, personnel dynamics and nursing management's role are crucial to success.

METHOD

A qualitative study of 44 ICU nurses from a South African tertiary hospital. Template analysis was used to identify themes. Manifest content analysis established the frequency of those themes.

RESULTS

Psychological content elements were predominantly relational in nature. Nurses' contracts were fulfilled by nursing managers, peers and patients. Examples of breach included unfairness, abuse of trust and public reprimands.

CONCLUSIONS

The nature of the work, the emphasis on professional and caring values, as well as the relational and intrinsic aspects associated with these, provide important indicators for the composition of nurses' psychological contracts.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding ICU nurses' expectations can ensure that their psychological contracts remain positive and fulfilled. Practical suggestions include public and private appreciation, autonomy, and management visibility and discretion.

How do nurses' work arrangements influence nurse managers' communication? A qualitative study

AIM

To understand how nurses' work arrangements influence nurse managers' communication with their nurses.

BACKGROUND

Transient work relations affect nurse coordination and the way nurse managers work, especially since giving feedback is an important managerial responsibility.

METHOD

Semi-structured interviews conducted between June 2016 and November 2017.

RESULTS

Although professional communication on direct patient care is mostly standardized, nurses' work arrangements influence how nurse managers mentor and provide feedback.

CONCLUSION

Facilities must explore avenues to provide nurse managers with adequate resources so that they can mentor both permanent and temporary nurses to their full professional potential. The implementation of formal mentoring programmes is important to ensure that temporary nurses receive the same information and support that permanent nurses receive and that permanent nurses feel comfortable to critically evaluate information from trusted sources.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers with limited mentoring resources may have to make practical decisions on whom they mentor, but this practical approach becomes a problem when nurses who do not receive adequate mentoring bring their deficiencies to other facilities. The rise in alternative work arrangements requires a shift in thinking about mentoring as a managerial responsibility to improve nursing care delivery universally and not unit specific.

Power, trust and motivation in hospitals

PURPOSE

The purpose of this paper is to improve understanding of how different kinds of power influence trust and motivation in hospitals.

DESIGN/METHODOLOGY/APPROACH

To analyze the links between power, trust and motivation, a framework of social power is tested on measures of trust in managers and motivation. Quantitative data from 137 respondents were collected. Partial least square is used to evaluate the theoretical model.

FINDINGS

Legitimate, referent and reward power has a positive influence on trust, while coercive power has a negative influence on trust. In total, 41.8 per cent of the variation in trust in managers was explained by power. Trust, reward power and expert power explained 30.9 per cent of the variation in motivation.

PRACTICAL IMPLICATIONS

The research indicates that in knowledge organizations such as hospitals, leaders should be careful in using coercive power. Expert power seems to influence motivation but not trust, while legitimate power seems to influence trust directly and motivation only through trust. Referent power seems to have a weak influence on trust and no direct influence on motivation. Reward power has a very strong influence both on trust and motivation.

ORIGINALITY/VALUE

It is important for leaders to consider how power can influence trust, motivation and the performance of a health organization. Although this study was conducted in Norway and Finland, the findings may have relevance on a broader scale.

The Social Determinants of Nursing Retention in a Pediatric Hematology/Oncology Unit

Pediatric hematology/oncology units (PHOUs) are highly paced, stressful environments and can be difficult areas to work. Thus, these units can present issues when it comes to both recruiting and retaining health care professionals (HCPs). There is scant research addressing how the environment of a PHOU contribute to a HCP's desire to stay or leave this environment. To conduct this project, a critical ethnographic approach was used. The researcher conducted semistructured interviews ( n = 29), which included nurses ( n = 21), physicians ( n = 4), and allied health care staff ( n = 4). This sample represented approximately one third of staff in each category. Participants identified that their ability to develop long-term relationships with children and families as a significant source of satisfaction. Belonging to the oncology team was seen as extraordinarily important to all the participants. The majority of the participants also felt that working in this ever-evolving dynamic medical field afforded them with ongoing learning opportunities. The main frustration described by participants pertained to administrative involvement in the everyday workings of the PHOU, potentially leading to attrition. It is important to note that there was also diversity among and between the categories of HCPs when describing the work environment and the issues that most influence them. While similarities among participants were found between satisfaction and dissatisfaction, significant differences between them led us to believe it would be unreasonable to attempt to compare the three groups here. Thus, in this article the author focused primarily on nursing while noting related observations from physicians and allied health professions.

Building trust: The influence of mentoring behaviors on perceptions of health care managers' trustworthiness

BACKGROUND

In health care organizations, trust is critical for effective workplace relationships that ensure patient-centered outcomes. Although research has focused on trust in the relationship between patients and clinicians, less is known about what influences workers to trust their managers. An understanding is needed of the specific behaviors that influence health care workers' evaluations of their managers' trustworthiness. Mentoring research focuses on the developmental assistance that a more experienced worker provides to a less experienced worker. Building upon seminal research on mentoring functions, we argue that health care managers can build trust by providing informational (career-related) and interpersonal (psychosocial) support.

PURPOSE

The aim of the study was to investigate the influence of health care managers' informational and interpersonal mentoring behaviors on workers' perceptions of their managers' trustworthiness and the mediating role of trustworthiness on trust in the managers.

METHODOLOGY/APPROACH

Surveys were completed during work hours by 315 health care workers at an acute care hospital and associated clinics in the Midwest.

FINDINGS

Results showed that managers' mentoring behaviors influenced worker perceptions of their managers' trustworthiness, in terms of ability, integrity, and benevolence. Ability partially mediated the relationship between informational mentoring and trust in managers, whereas integrity and benevolence partially mediated the relationship between interpersonal mentoring and trust in managers.

PRACTICE IMPLICATIONS

Health care managers can actively build trust through mentoring behaviors that inspire positive assessments of managers' ability, integrity, and benevolence.

Challenges faced in rural hospitals: the experiences of nurse managers in Uganda

AIM

The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda.

BACKGROUND

The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff.

METHODS

This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study.

RESULTS

Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'.

DISCUSSION

Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff.

CONCLUSION

Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development.

IMPLICATIONS FOR NURSING POLICY

It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development.

Support of the nurse

AIM

A multidisciplinary concept analysis of support of the nurse.

BACKGROUND

Nurses provide support on a daily basis to their patients and this aspect of support has been well established in current literature, yet support of the nurse rather than from the nurse is not readily established in recent research. The gaps in the analysis of support of nurses are addressed from a multidisciplinary approach.

METHODS

Using the Walker and Avant's method, a concept analysis of support of the nurse was conducted. Electronic databases (CINAHL, MedLine, and PyscINFO) were searched using the terms support, concept analysis, and nurse. Of the 27 articles found in the search, only seven articles met the inclusion criterion of nurse as primary subject matter.

RESULTS

The three defining attributes of support are a safe environment, connection, and communication. Antecedents of support include accessibility and information. Consequences of support are relationships formed and empowerment. The empirical referent highlighted in current literature is the Multidimensional Scale of Perceived Social Support.

CONCLUSION

While the support that nurses provide to patients has been studied for years, there is a lack of studies addressing the concept of support of nurses. Future research could fill this gap by investigating support of nurses in holistic ways, such as qualitative or mixed-method analysis. Support is not always accessible in a face to face format, so mobile and web options are presented as possible interventional opportunities to meet nurses at the bedside.

The role of the psychological contract in the motivation of nurses

Purpose Although private health care is regarded as providing a premium quality experience for both patients and staff alike, it is not without its daily challenges for health professionals. This study aims to explore the psychological contract of nurses to develop a greater understanding of how employee-employer interaction impacts motivation levels. Design/methodology/approach Data were gathered through semi-structured interviews with thirteen nurses at a private hospital in South Africa. Five nursing managers were interviewed to provide a management perspective. Thematic analysis was used to identify the salient elements of the psychological contract and to establish connections with motivational features. Findings The psychological contract of nurses was balanced in nature, contained predominantly relational elements and was characterized by the need for manager support, leadership and autonomy. Motivation was a by-product of fulfilment and was enhanced by a combination of tangible and intangible rewards. Practical implications Nursing managers should recognize their role in caring for the wellbeing of their staff and should be trained accordingly. Equipping nurses with the necessary tools to work autonomously, as well as acknowledging their skills, will stimulate confidence and improve motivation. Originality/value This study makes an important contribution to the existing literature on the psychological contract of nurses within the health-care system. It provides insight into relationship-based mechanisms that can be used to improve the motivation of nurses and thus impact the overall quality of patient care.

Trust in Supervisor and Job Engagement: Mediating Effects of Psychological Safety and Felt Obligation

In the social context of job engagement, the role of trust in supervisor in predicting engagement of employees has received attention in research. Very limited research, however, has investigated the mechanisms mediating this dynamic relationship. To address this important gap in knowledge, the aim of this study was to examine psychological safety and felt obligation as two psychological mechanisms mediating the effect of trust in supervisor on job engagement. Drawing from job engagement and social exchange theories, the mediating roles of psychological safety and felt obligation in the trust-engagement relationship were empirically investigated in the Malaysian context. Using self-report questionnaires, data were collected from 337 nurses employed in a public hospital located near Kuala Lumpur, Malaysia. Results fully supported the proposed serial multiple mediator model. Trust in supervisor was indirectly related to job engagement via psychological safety followed by felt obligation. This study provides empirical evidence that trust in supervisor makes employees feel psychologically safe to employ and express their selves in their job roles. This satisfaction of the psychological safety need is interpreted by employees as an important socioemotional benefit that, in turn, makes them feel obligated to pay back to their organization through their enhanced level of job engagement. Implications for theory and practice were discussed.

An extra care community's perceived priorities for 'whole system' relationships: a Q-methodological study

Health and social care settings worldwide need to sustainably improve the quality of relationships across communities or 'whole systems'. This research informs the development of a relational framework based on stakeholder perspectives. It is grounded in an action research project with practitioners, and draws on a previous literature review, to present the underpinning elements of quality relationships as statements, organised under the headings of integrity, respect, fairness, compassion and trust. Using Q methodology, 27 participants, comprising a range of stakeholders (staff, residents, family and service providers), rank-ordered 48 statements based on perceptions of the importance of differing aspects of relationships. By-person factor analysis was used to create five factors or viewpoints by comparing and contrasting using the composite rankings alongside interview data collected for each participant. The first view 'Altogether now' prioritises compassionate engagement. Second, 'Respect is a two-way street' emphasises the need for reciprocal respect and recognition of history. The factor labelled 'Free spirits' posits the dominant view of freedom. The fourth view 'Families … strengths and challenges' focuses on the necessary and complex involvement of families and finally, 'Helping hands' emphasises the role of relationships in increasing previously low expectations of social integration for previously isolated residents. The different views that exist on the composition of quality relationships can be used to help extra care communities to understand and utilise relationships as a powerful and effective resource.

Optimising the benefits of community health workers' unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries

Community health workers (CHWs) have a unique position between communities and the health sector. The strength of CHWs' relationships with both sides influences their motivation and performance. This qualitative comparative study aimed at understanding similarities and differences in how relationships between CHWs, communities and the health sector were shaped in different Sub-Saharan African settings. The study demonstrates a complex interplay of influences on trust and CHWs' relationships with their communities and actors in the health sector. Mechanisms influencing relationships were feelings of (dis)connectedness, (un)familiarity and serving the same goals, and perceptions of received support, respect, competence, honesty, fairness and recognition. Sometimes, constrained relationships between CHWs and the health sector resulted in weaker relationships between CHWs and communities. The broader context (such as the socio-economic situation) and programme context (related to, for example, task-shifting, volunteering and supervision) in which these mechanisms took place were identified. Policy-makers and programme managers should take into account the broader context and could adjust CHW programmes so that they trigger mechanisms that generate trusting relationships between CHWs, communities and other actors in the health system. This can contribute to enabling CHWs to perform well and responding to the opportunities offered by their unique intermediary position.

Trust in African Americans' Healthcare Experiences

PURPOSE

The purpose of the study is to clarify the concept of trust, identify its defining attributes, antecedents, and consequences, and apply to the healthcare experiences of African Americans.

BACKGROUND

For African Americans, mistrust in the healthcare system is the result of unequal treatment that began in slavery. Fear and negative experiences engender a reluctance to trust healthcare providers, which contributes to health disparities.

DESIGN

Walker and Avant's method of concept analysis was used to clarify the concept of trust. The concept was applied to African Americans' healthcare experiences with discussion of opportunities for trust building.

DATA SOURCE

Data support for concept development was done using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and online reference sources.

REVIEW METHODS

Literature review was guided by using the keyword trust. Further contextual explication was done by adding a review of literature from sociology and history regarding the evolution of African American mistrust of the U.S. healthcare system.

RESULTS

The defining attributes of trust are dependence, willingness, and met expectations. Antecedents to trust include a need requiring the help of another and prior knowledge or experience. The consequence of trust is an evaluation of the congruence between expected and actual behaviors of the trusted person or thing. Literature review of the African American culture adds a dynamic aspect for nurses to consider when developing relationships in minority communities.

CONCLUSION

Trust is the willingness to enter a dependent relationship to have the needs addressed, and is maintained by met expectations. Rebuilding trusting relationships between providers and African American patients is a vital step toward reducing health disparities. Murray.