Pathway to Trust: A Middle-Range Theory

Background and Purpose: Trust is interpersonal, between two people, or institutional, in an institution or profession such as nursing. The patient developing interpersonal trust with the nurse is fundamental to nursing care. The purpose of this study was to develop a middle-range theory of interpersonal trust development in the nurse-patient relationship. Methods: The middle-range theory Pathway to Trust was synthesized from three grounded theory studies on the development of trust in the nurse-patient relationship with hospitalized patients. One study was conducted with English-speaking Mexican American adults, a second study with Spanish-speaking Mexican American adults, and the third study with non-Hispanic adults. The three models were synthesized into an empirically based middle-range theory of how interpersonal trust develops between the hospitalized patient and the nurse. Results: The Pathway to Trust has a beginning, middle, and end phase. At the beginning, the patient is vulnerable, relying on the nurse. In the middle, the nurse enters focused and available to the patient, perceived as caring about the patient. In the end, the patient develops trust, feeling comfortable with the nurse. A key consequence of trust is the patient allowing the nurse to help and confiding in the nurse. If the trust does not develop, the patient may avoid the nurse and not ask for help which is a patient safety concern. Implications for Practice: The Pathway to Trust is useful for advancing nursing practice, education, and research globally. Developing trust with the patient impacts patient safety and quality of care.