Trustworthy

How much does trust matter to you? Is it something you value? Trust is a key component of the fourth theme of the Code; promote professionalism and trust.

Students and registrants are expected to be committed to the standards of practice and behaviour set out in the Code. Such an approach should gain from clients, carers, members of the public and other Health Care professionals, trust and confidence in the profession of nursing.

The NMC (2015)

Why is trust so important?  Nurses and midwives have the privilege of engaging with individuals who are often vulnerable as a result of the effects of distress and or disease.  Ideally members of the nursing profession are individuals that no one wants to have to encounter but when they need to they expect that the nurses they meet will be reliable, responsible and dependable.

Nurses and midwives must tell the truth. Members of the public expect nurses to be honest and trustworthy, at all times but perhaps particularly so when things have gone wrong and mistakes have occurred. This was recently illustrated by the comments of an individual with a terminal illness that she made to those responsible for her care, and shared with her permission, “all I want, and expect, is that all staff caring for me treat me as an individual and always tell me the truth.  Telling me now that the primary cause of my illness cannot be found and that things I have been previously told about my condition were wrong is not going to affect my situation, but I appreciate you telling me. I know I am going to die and there is nothing more that can be done for me so please don’t shake my trust in you by pretending otherwise. I need to be able to trust you, to know you will always tell me the truth. It’s not your fault I’m dying, it’s the disease which is killing me.  I’m not interested in suing you, I just want you to be honest with me”.

Nurses occupy a position of trust and are expected to maintain the standards expected of them upholding the reputation of their profession at all times. The NMC in its guidance regarding Cases with particular risks for public confidence  comment that “dishonesty, even where it does not result in direct harm to patients but is related to matters outside of a nurse or midwife’s professional practice can undermine the trust the public place in the profession. Honesty, integrity and trustworthiness are to be considered the bedrock of any nurse or midwife’s practice“. NMC 2017.

Third year students at the University of Salford will shortly be grappling with some recent registrant fitness to practise cases as a part of their ongoing professional development.  They will perhaps discover that, as Mark Twain commented,  “truth is stranger than fiction”.

You may be familiar with the courtroom oath / affirmation “The truth, the whole truth and nothing but the truth” perhaps not because you have spoken those words yourself but have witnessed them being spoken in some form of dramatic setting. Telling the truth in court is essential and not just because there is a fear of being charged with perjury should it subsequently be discovered that witness lied but because judgements about the truth can only be made fairly if everyone behaves and speaks honestly. In a criminal court the standard of evidence must be “beyond all reasonable doubt”, the logical explanation / interpretation of the evidence is that the defendant committed the crime.

The civil standard of proof; “balance of probabilities” requires that the decision makers must the conclusion that what is alleged to have occurred is more likely to have occurred than not to have done so. This is the standard of proof which is used to adjudicate the fitness to practise of registrants.

Dishonesty in a registrant, even if short lived, and if it did not cause any harm to clients is always a serious matter. The Nursing & Midwifery Council’s consideration of fitness to practise cases which involve dishonesty frequently include reference to  Mr Justice Mitting’s comments in the case Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 in which it was made clear that dishonesty always gives rise to a “severe risk” of having the registrant’s name erased from the register. Dishonesty comes in many forms and must be carefully assessed. There is a difference in  severity between deliberate, planned, deceptive acts which pose a risk to clients or involve client harm, or breach the trust of vulnerable clients and opportunistic, one-off incidents arising in the registrant’s private life which pose no risk to clients. The former modes of dishonesty are most likely to result in consideration of the continuance on the register of the individuals who perpetrate such acts.

We may spend many years building up trust only to discover that suspicion, not proof, destroys it. Think of how many public figures; including actors, sports people and politicians, you are aware of who have had their reputations shattered by comment not proof.

The Nursing & Midwifery Council published its latest guidance on “Making decisions on dishonesty charges” on 15 December 2017, and it makes for interesting reading. It is well worth the effort to read the Supreme Court Judgment given on 25 October 2017 which is referred to by the Nursing & Midwifery Council in its guidance. The case is about a professional gambler who sues a casino for winnings and raises questions about “the meaning of the concept of cheating at gambling, the relevance to it of dishonesty, and the proper test for dishonesty if such is an essential element of cheating”. The judgment of the Supreme Court Ivey v Genting Casinos [2017] UKSC 67, The more warped the defendant’s standards of honesty are, the less likely it is that he will be convicted of dishonest behaviour……..” is the problem with the Ghosh test for dishonesty (the leading authority on the concept of dishonesty in law). The Supreme Court concluded that Ghosh does not correctly represent the law and directions based upon it ought no longer to be given.

Truth would seem to have the ability to elicit a whole raft of emotions and feelings; the truth will set you free, the truth hurts, it is its own reward said Plato, it is rarely pure and never simple commented Oscar Wilde. Many individuals claim to experience great relief and peace from telling and hearing the truth as was the case of the woman cited in the anecdote above.

We should all ensure that all our actions, comments and thoughts make us trustworthy practitioners.

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31 thoughts on “Trustworthy

  1. This was very informative and useful to know the importance of telling the whole truth in its most accurate form. The article is very good as it emphasis the importance of how dishonesty can cause harm to a nurse or student nurse’s reputation.

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  2. Yes, by being truthful as nurses in dealing with our clients we will be promoting professionalism and trust. There is trust within the team, our patient are comfortable and safe, our main priority. In instances where we go wrong we tell the truth and it will set us free. A powerful piece of work moulding us to be good, truthful, trustworthy nurses.

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  3. Nearing the end of my first year of the Adult Nursing degree I couldn’t agree more with the article above. I have noticed when you are honest and trustworthy the person in your care will be honest with you too, making the care you give them more effective. That moment of awkward truth telling could make a lifetime of difference to those in our care.

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  4. Trust is important as promotes communication between health professionals and clients, it gives them reassurance that if the health professional is being honest with them then they are also being honest with the care being given. It is considered to be a very important part of the Nursing and midwifery council Code.

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  5. This blog reiterates how trust on a personal level can also impact upon the wider community.
    Honesty can assist the client greatly through out their time in your care and is essential in the client gaining trust in the care that they are receiving.

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  6. I agree wholly with this article, as even if there is nothing you can do to save a person, gaining their trust and being honest with them will help them feel at ease and caring for them will make an even bigger impact on their experience.

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  7. I agree that trust is very important in nursing because it allows patients to feel comfortable, it is especially important in children’s nursing because there needs to be trust between the child and the nurse and the parents as well so that they can believe that everything will be done to help the child.

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  8. As Nurses we have a duty of candour, a duty to be open and honest with the client about their conditions, treatment and care. This article highlights this duty and how important it is to be truthful with a client as it develops the trusting relationship between the client and the professional; it will also make the client feel at ease which is important.

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  9. Being trustworthy, and having trust for individuals, patients and clients is of high importance to create a good professional relationship as a healthcare professional with your patients and their families. People in your care will want to know that they are being cared for by health professionals they can trust and can rely on to be truthful and honest regarding their health, and needs.

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    1. Enjoyed reading this article, it is crucial to have great professional relationships with other healthcare professional, patients and families.

      Also with regard to staffing, recruitment and students enrolling where numbers are declining, I am excited to see how the nursing associate role will improve overall patient care and moral of hardworking healthcare professionals.

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  10. I agree that trust is extremely important as a nurse and healthcare professional, as when patients are in our care they are relying on us to deliver the best possible care we can which includes being honest with them. Trust is needed to build a professional relationship between nurse and patient as we have a duty of candour and must also ensure the patient has a say in their care.

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  11. I agree with this blog, I think trust is extremely important for both Students and Registrants. Patients expect us to be honest and trustworthy and therefore it is our duty to provide that. This helps build professional relationships with patients and the health professional and as it was mentioned in the blog ”Trust is a key component of the fourth theme of the Code; promote professionalism and trust.” Therefore we need to follow this to be competent Nurses who are able to maintain there name on the NMC register. Its also the patients basic rights to be told nothing but the truth and be able to trust the Nurse.

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  12. As a student children’s nurse I am aware that it is not only the child in my care that will be trusting me to look after them , but also the parents. Trust is gained through honesty and integrity with the clients.

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  13. Trust is one of the most important things when building rapport with the patient as they must feel safe and able to trust you when in your care. Therefore, it is important to always be honest with them, whether the information given is positive or negative. This information must also be shared with the family so that they can also trust me as their child’s nurse. Both the student and registrant should make it a priority to carry out the duty of candour, and behave with integrity at all times. Upholding the NMC Code of Conduct is of prime importance in order to deliver the best quality care. Honesty is always the best policy. This post highlights this ideology perfectly.

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  14. I agree with the blog on the importance of trust. Trust is a reciprocal process and can be built between patient and carer by the carer being honest about the health of the client therefore the client will also be more likely to be honest. A trusting relationship between client and caregiver ensures the client is comfortable and at ease knowing they are being cared for by trusted health care professionals.

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  15. Holly Etchells CYP NURSE
    I completely Agree with this article and this is because it is important that nurses are professional and trustworthy so that trust is built with between the patient and Nurse. As a CYP student nurse i also recognise that not only are the children relying on us to deliver the highest standard of care but also the parents and this is why it is important to be completely honest with the clients and their families. A trusting relationship between the client and the nurse can make the client feel comfortable and also trusted in the care they are given.

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  16. Danielle Rigby

    This blog reiterates how important it is to build trust with your patient. Students and registered nurses should be committed to building trust with both the patient and their family, while following the guidelines set out in the code. As nurses we have a duty to be honest to our clients about their condition. I feel that this blog outlines that building trust with your patient will only improve the professional relationship and I believe that it will make them feel more at ease in your company.

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  17. This article highlights that Nurses have a duty of candour, which is to be open and honest with the patient about their condition, treatment and plan of care. This will help build trust with your patient and their family as well.

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  18. I agree with the article as, as a childrens nurse we have the responsibility to be trustworthy and gain the trust of both the child and their parents. This is important in all aspects of their care such as treatment, medication, outcomes etc.

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  19. This article outlines the essential connection between honesty and trust; it is understandable why people find the truth hard, especially as a practitioner. However if trust between client and practitioner is essential for co-operation, then there is no excuse not to be honest at all times. Trust is a valuable entity and should be treated with caution and protection.

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    1. As a third year mental health nurse, trust and truthfulness with patients is often something that is hard earned via a positive and productive therapeutic rapport. I have met patients who have had poor experiences with the mental health services, especially in relation too feeling that diagnosis has been withheld from them, or not feeling properly engaged in their own treatment (especially when being treated under the MHA). That this is still a commonly voiced feeling by patients is a concern, although equally I have met many excellent nurses who are consistently honest with patients even in difficult circumstances. To have the trust of patient is a valuable honor which we should safeguard as nurses, and i think reflective practice and being aware of the potential power we hold is very important in this regard. Of course, such issues are related to the minimum expectations set out in the NMC Code (duty of candor, for instance) but as good practitioners we should bare in mind that this outlines expectations of care, and that as nurses we can strive to exceed these with good practice and consistently compassionate, person centered care.

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  20. I think that being honest is a core component of providing transparent care to our patients. I have a background working within NHS complaints and am now a student nurse. Within both roles there appears to be an unspoken angst surrounding being open about what is / is not achievable; providing clear lines of communication and setting realistic expectations with patient and those significant to them. However, as the article and many other have noted, each of these things help to build trust which is key for any significant interaction. Particularly health professionals who have contact with patients / clients presenting at times when they are vulnerable

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  21. I am a second year Adult Nursing student and agree that trust is an essential element in partnership care between a practitioner and client. According to the 2017 Gallup Poll the general public views nurses as the most trust-worthy professionals. As a student it is an honour to be going into a profession held in such high regard, however, I also understand I have a duty to uphold my position as a student and eventually a registrant. I refer to the NMC Code frequently in order to reflect and develop my practice.

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    1. Many nursing students know that trusting relationships between a nurse and client are an important part of a therapeutic relationships, but living what we preach can prove to be a different matter. Lack of understanding communication skills, professional attitudes and personal values can blur the concept of honesty for many. In our personal lives, little white lies or omissions may not seem important. In our chosen profession as a nurse, it weighs quite a bit more. In fact, it is, as the article implies, our profession’s reputation that is at stake. It is also the tie that binds vulnerable clients to nurses, carrying potential to facilitate faster recoveries and more desirable outcomes. This is why The Code is so important. It is a source of redirection for some and a constant reminder of who we are meant to be as representatives of the profession.

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  22. The article readdresses the importance of gaining trust between nurse, patients, and families. Building trust is an integral part of effective communication, which is one of the 6 C’s in nursing care. we as nurses are there to maintain a professional manner and follow policies and guidelines in our own practice therefore being open and honest is respecting the patient and having a duty of candour. Each nurse is unique to that individual patient, nurses need to be mindful of this as the patient will always remember what you didn’t do as a healthcare professional opposed to what you did do right.

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  23. This article emphasises the importance of trust and truthfulness with our patients, which is needed to build a good rapport with our patients and the importance of the duty of candour and that patients should have an active role in their care.

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  24. Tamar Khelisupali (Adult Nursing student, 2 year)

    I think we all agree that lack of trust is a barrier to successful therapeutic relationship… and therapeutic relationship is what makes the patient feel that they are respected as a personality and that they actually matter.
    I do agree that very often truth hurts but … I’ve seen the nurse, who made mistake and did not try to hide it. Instead he explained everything to the patient… and to my surprise, the patient said that he understands as we all are human beings.
    This again highlights importance of 7th C of Nursing, Candour. “All healthcare professionals have a duty of candour – a professional responsibility to be honest with patients, when things go wrong. “

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  25. Trust is an important start to building a therapeutic relationship between a nurse and her patients. It is also our professional responsibility to protect the integrity of our patients. The Nurse have a duty of candour to be open and honest to her patient and her trust when things goes wrong. It is essential to also own up as quickly as the mistakes has happen as it can prevent further incidents.

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  26. As a first year student, I agree that trust is fundamental when it comes to building professional rapports with patients.

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