Application of the Reina Trust and Betrayal Model to the Experience of Pediatric Critical Care Clinicians

Abstract

Background Trust is essential in the workplace, yet no systematic studies of trust among pediatric critical care professionals have been done. Objective To determine the feasibility of measuring trust in a pediatric intensive care unit by using established scales from the corporate world and to determine what behaviors build, break, and rebuild trust. Methods The Reina Trust and Betrayal Model was used to explore contractual, competence, and communication trust. Nurses and physicians in a pediatric intensive care unit completed online surveys to measure organizational, team, and patient trust. Quantitative data from 3 standard survey instruments and qualitative responses to 3 open-ended questions were analyzed and compared. Results Quantitative data from all 3 instruments indicated moderate to high levels of trust; scores for competence and contractual trust were higher than scores for communication trust. Scores indicated agreement on behaviors that build trust, such as pointing out risky situations to each other, actively striving to build supportive and productive relationships, and giving and receiving constructive feedback. Foremost among trust-breaking behaviors was gossip, which was more troublesome to respondents with longer experience in critical care.Responses to the open-ended questions underscored these themes. The most frequently cited items included encouraging mutually serving intentions, sharing information, and involving and seeking the input of others. Conclusion The Reina trust scales and open-ended questions are feasible and applicable to pediatric critical care units, and data collected with these instruments are useful in determining what behaviors build, break, and rebuild trust among staff.

Understanding trust between pediatric hospitalists and outpatient clinicians during hospital admissions: A multisite qualitative analysis

“…16,17 We used the literature review of "trust," "respect," "mutual acquaintanceship," and "power" as described by Karam et al 18 to inform our approach. In this review, six concepts negatively affecting trust between interprofessional colleagues are described: (1) doubting the other's motivation in providing care, (2) feeling threatened by the other's involvement, (3) differences in philosophies and scope of practice, (4) negative images of the profession, (5) lack of confidence in the other's skills and lack of awareness of the other's role, and (6) respect for the profession and individual to balance power. These concepts were rephrased into neutral language to guide deductive coding.…”

“…4 Accordingly, a body of literature, physician education, and competency requirements focus on helping clinicians build and maintain trust with patients and families. [5][6][7][8][9] Despite recognition of the importance of trust between patients and clinicians, evidence describing trust between clinicians is sparse. Trust between clinicians may impact the quality of care a patient receives, patient and family trust in the medical system, and a patient's trust in an individual clinician.…”

“…Within medicine, trust between patients and clinicians is foundational to the provision of high‐quality healthcare and positive patient outcomes 3 ; it is linked to improved health‐related behaviors, patient satisfaction, and quality of life 4 . Accordingly, a body of literature, physician education, and competency requirements focus on helping clinicians build and maintain trust with patients and families 5–9 . Despite recognition of the importance of trust between patients and clinicians, evidence describing trust between clinicians is sparse.…”

Institutional betrayal in nursing: A concept analysis

“…20 The Reina Organizational Trust Scale ® is a 54-item scale used to measure levels of trust within an organization, focusing on experiences and interactions with peers and managers within an organization and measuring trust conveyed through those interactions. 14 The Moral Injury Symptoms Scale–Healthcare Professional version (MISS-HP) was created to measure moral injury among healthcare providers and includes an item measuring level of agreement with the statement “I feel betrayed by other healthcare professionals whom I once trusted.” 21 Single questions have also been used to determine betrayal. 13…”

“…13 Betrayal as a work environment issue could include an organization or its leaders engaging in deceitful communication, disregarding the needs of patients and providers, and failure to make decisions in the best interests of others. 14 Organizational betrayal has been used as a term to describe work environments where organizations responded to negative workplace issues with hostility toward the victim, demonstrating a lack of concern about the issue, or creating an environment where the issue was likely to occur. 15 Betrayal was used in some articles to describe a form of moral issues faced by nurses.…”