Trust between nursing management and staff in critical care: a literature review

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.

Can nursing educators learn to trust the world's most trusted profession?

Nursing and nursing education face a paradox whereby the world's most trusted profession seems not to trust its own students and practitioners. Much of nursing education has adopted what has been memorably described as the 'cop shit' approach. This is the panoply of surveillance, anti-plagiarism and proctoring technologies that appear to be used more for policing and punishment of an inherently dishonest student body than to develop ethical and scholarly writing among future peers and colleagues. Nurses in practice may experience similar levels of distrust as they face growing micromanagement and control of both their appearance and nursing practice. We propose that these practices of distrust emerge, not from malice, but rather from the omnipresent neoliberalism and managerialism that engulf almost every aspect of health and university life. Neoliberalism's success has been to reformat academia and practice to the point where such ingrained mistrust has become merely a neutral recognition of 'the real world'. Dismantling nursing and education's 'cop shit' culture and replacing it with the trust and respect that the world's most trusted profession is accorded by wider society will not be easy, but it is vital for the future of nursing.

Perspectives of Australian hospital leaders on the provision of safe care: implications for safety I and safety II

Purpose

There is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the perspectives of hospital leaders on the challenges of leading safe care.

Design/methodology/approach

This paper reports the findings of a three-year longitudinal study of eight Australian hospitals. A representative sample of hospital leaders, comprising board members, senior and middle managers and clinical leaders, participated in focus groups twice a year from 2015 to 2017.

Findings

Although the participating hospitals had safety I systems, the leaders consistently reported that they relied predominantly on their competent well-meaning staff to ensure patient safety, more of a safety II perspective. This trust was based on perceptions of the patient safety actions of staff, rather than actual knowledge about staff abilities or behaviours. The findings of this study suggest this hegemonic relational trust was a defence mechanism for leaders in complex adaptive systems (CASs) unable to influence care delivery at the front line and explores potential contributing factors to these perceptions.

Practical implications

In CASs, leaders have limited control over the bedside care processes and so have little alternative but to trust in “good staff providing good care” as a strategy for safe care. However, trust, coupled with a predominantly safety 1 approach is not achieving harm reduction. The findings of the study suggest that the beliefs the leaders held about the role their staff play in assuring safe care contribute to the lack of progress in patient safety. The authors recommend three evidence-based leadership activities to transition to the proactive safety II approach to pursuing safe care.

Originality/value

This is the first longitudinal study to provide the perspectives of leaders on the provision of quality and safety in their hospitals. A large sample of board members, managers and clinical leaders provides extensive data on their perspectives on quality and safety.

The relationship between trust in first-line nurse managers and organizational commitment

AIM

To determine the effects of nurses' trust in first-line nurse managers on their organizational commitment.

BACKGROUND

Trust in managers is known to have important effects on employees' organizational commitment.

METHODS

A descriptive, cross-sectional and correlational research design used in this study. The sample was selected using proportional quota sampling which consisted of 723 nurses working in four hospitals in Istanbul (n = 723). The data collection tools were a nurse information questionnaire, the Trust in Manager Scale and the Organizational Commitment Scale. The data were analysed using descriptive tests, correlation and regression analysis (backward elimination).

RESULTS

The three regression models which were developed in this study were significant. In these models, the affective commitment subscale had the highest explanatory rate (29.5%). The variables such as being over 40 years old, being employed in a public institution and working on a permanent day shift and the subscales of the trust in manager scale such as support for subordinates and providing a positive work environment were predictors that affected the nurses' organizational commitment scores positively.

CONCLUSION

The study results show that trust in nurse managers is a determinant of nurse's organizational commitment.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

First-line nurse managers can increase nurses' organizational commitments by building their trust with positive and encouraging behaviours. Top managers should point out the role of trust in first-line nurse managers and indicate the components of trust that lead to positive organizational outcomes.

Trust towards nurses who care for haemodialysis patients: a cross-sectional study

BACKGROUND

Trust is widely acknowledged as the main component of relationships between patients and nurses.

AIMS

Considering the importance of building trust in the patient-nurse relationship especially in vulnerable patients such as patients undergoing haemodialysis, this study was carried out to assess the trust of these patients towards nurses in the haemodialysis unit and to explore its relationship with some characteristics of the patients.

METHODS

In this cross-sectional study, a total of 180 patients undergoing maintenance haemodialysis were selected using random sampling method. Data were collected by trust in nurses (TNS) scale. The collected data were analysed by SPSS (ver.21) software using anova, independent t-test and Pearson's correlation coefficient.

RESULTS

The mean score of patients' trust in nurses was 23.82, showing a high level of trust towards nurses. The lowest score (with a mean score of 4.17) was related to the providing of accurate information by nurses about the disease. Pearson's correlation coefficient indicated a positive significant relationship between the age and patient's trust (r = 0.17, p > 0.05), and there was a negative relationship between the mean score of trust and the mean of interdialytic weight gain (r = 0.57, p > 0.05).

CONCLUSIONS

Although the patient trust towards nurses was high in this study, there were some deficiencies in certain items especially in the provision of information and education to the patients. Education of specialised courses for nurses and empowering them to provide a high quality care to the patients on dialysis could help to increase the patents' trust.

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.

Factors influencing nurses' intentions to leave adult critical care settings

BACKGROUND

The shortage of critical care and specialist nurses has been an ongoing issue for many decades. Although all areas of nursing are affected, critical care areas are especially vulnerable to recruitment and retention problems. High nursing turnover in critical care areas is evident; however, research into the factors that influence nurses' intentions to leave adult critical care areas is limited.

AIM

To explore factors that may influence nurses' intentions to leave adult critical care areas.

OBJECTIVES

To appraise existing evidence and highlight gaps in knowledge regarding factors that may influence nurses' intentions to leave adult critical care areas.

METHODS

A systematic mixed-method literature review was conducted. The search strategy was developed using the List, Keep and Delete approach, a framework used to identify search terms for systematic health care reviews. The following key words were used: intentions to leave, nurses, adult and critical care. The databases searched were BNI, CINAHL, PubMed, PsycINFO, Embase and Health B Elite from 2005 to 2016. Primary data from non-critical care areas and neonatal and paediatric critical care areas were excluded. Comprehensive supplementary searching was performed. Papers were critically appraised using the NICE (2012) checklists. Data were analysed using the Braun and Clarke (2006) thematic framework.

RESULTS

A total of 15 studies, including 13 cross-sectional studies and 2 qualitative studies, were reviewed. Three main themes emerged following data analysis. These themes were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences.

CONCLUSIONS

The literature review highlighted the need for further research and greater understanding of how these themes may impact critical care nurses. Nurse managers and leaders should consider these findings when developing strategies to improve nurse retention.

RELEVANCE TO PRACTICE

The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care.

The Culture of Nurses in a Critical Care Unit

Critical care nurses have to adapt to a fast-paced and stressful environment by functioning within their own culture. The objective of this study was to explore and describe the culture of critical care nurses with the purpose of facilitating recognition of wholeness in critical care nurses. The study had a qualitative, exploratory, descriptive, and contextual design. The ethnographic study included data triangulation of field notes written during 12 months of ethnographic observations, 13 interviews from registered nurses, and three completed diaries. Coding and analysis of data revealed patterns of behavior and interaction. The culture of critical care nurses was identified through patterns of patient adoption, armor display, despondency because of the demands to adjust, sibling-like teamwork, and non-support from management and medical doctors. An understanding of the complexity of these patterns of behavior and interaction within the critical care nursing culture is essential for transformation in the practice of critical care nursing.

Perceptions of trust in physician-managers

PURPOSE

The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers.

DESIGN/METHODOLOGY/APPROACH

The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers.

FINDINGS

The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians' trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role.

RESEARCH LIMITATIONS/IMPLICATIONS

This paper's findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers.

PRACTICAL IMPLICATIONS

The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities.

ORIGINALITY/VALUE

The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.

Restoring trust in the pharmaceutical sector on the basis of the SSRI case

The lack of public trust in the pharmaceutical sector (i.e. industry, authorities and doctors) could compromise the future of drug development and the regulatory system. Public trust integrates two important components, namely the vulnerability of the truster and the competence of the trustee. Because trust appears to have eroded as a result of drug safety controversies, this paper analyzes the role of public trust during the selective serotonin reuptake inhibitor (SSRI) and suicidality controversy focusing on the aforementioned trust components. Because the competence component of trust is argued to be paramount in determining and maintaining public trust, the SSRI case shows that this component is a part of public trust where these institutions can build on, and might therefore be better used to substantiate and reinforce, public trust. Efforts to build trust should rely on the ethical, professional (competence) and societal commitment of institutions and individuals to protect the vulnerability of the public during controversies. Because shared values can create trust or increase its levels within a specific environment, industry, authorities and physicians ought to develop novel and cooperative strategies to highlight their shared values and motivations. Rules, regulations and settlements are indispensable tools but undue regulation is costly and can backfire on the rather sensitive trust relationships in the pharmaceutical sector.

Behavior Critical to Trust in Nursing Leadership at a Highly Complex Hospital

Objetivo: esta investigación tiene por objetivo identificar el tipo de conductas de las jefaturas de enfermería más frecuentemente relacionadas con experimentar confianza hacia ellas según los funcionarios de la salud y determinar con cuál dimensión de la confiabilidad está más relacionada. Método: la investigación fue de índole cualitativa y participaron 90 funcionarios de un hospital público de alta complejidad en Chile; un 26,7 % eran enfermeras(os) y un 73,3 % técnicos paramédicos. Se utilizó la técnica de incidentes críticos para la recolección de datos. Se llevó a cabo un análisis fenomenológico interpretativo de las entrevistas semiestructuradas obteniéndose 66 incidentes críticos. En la entrevista se solicitó que describieran un incidente específico, significativo, que hubieran experimentado con su jefatura de enfermería. Resultados: se identificaron cuatro categorías: Ayuda instrumental ante problemas, Apoyo emocional, Apoyo y defensa ante ataques y Apoyo al empoderamiento. Se encontró que todas las categorías corresponden a la dimensión benevolencia de la percepción de confiabilidad del líder. Conclusión: experimentar confianza en la jefatura se facilita cuando las enfermeras jefes ejercen un liderazgo que establece una confianza basada en un vínculo emocional positivo con los funcionarios, demostrando una preocupación cuando ellos enfrentan dificultades, tanto laborales como familiares, prestándoles entonces ayuda o apoyo emocional o profesional.