CPNRE® Comprehensive Review Series: Part 5





As we continue our serialization of the CPNRE® Comprehensive Review eBook, we’re talking about important elements of our interactions with clients – including how ‘not’ to be. Here’s part 1, part 2, part 3, and part 4 in case you missed them. 

Nurse-client interactions: Mistrust

When we talk about trust, it’s important to also understand the opposite: mistrust.

One of the best definitions of mistrust I’ve found is by Charles Feltman. He defines mistrust as ‘assessing that what is important to me is not safe with this person in this situation’. In other words, mistrust is choosing to not expose ourselves or share certain things we value with someone else in certain circumstances.

For example,

  • When someone lies to us, we may become doubtful of trusting that person to tell us the truth.
  • When someone steals from us, we may become hesitant to believe they won’t steal from us again.
  • When someone important in our life repeatedly fails to do what they say they would, we begin to question their reliability.
  • When someone criticizes us, we may feel the need to protect ourselves from what they might say in the future.
  • When someone physically hurts us, we may feel that we are not physically safe.

Sometimes we easily trust others and withdraw our trust only when it is betrayed, and sometimes we only learn to trust someone over time. Regardless of how easily trust is established, we know that trust is fragile and easily destroyed.

The problem with mistrust in nursing is that it becomes a barrier to helping clients get the care they want and need. When clients mistrust their nurse, they may not feel like it’s safe to share personal information, or they may not feel that it’s safe to allow their nurse to provide their physical care. We often don’t realize it, but the consequences can be disastrous. Not only do clients question their trust in a single provider, they may also lose their trust in an entire organization or profession.

I can’t tell you how many clients I’ve seen over the years who don’t seek help for serious health issues because they mistrust their health care provider. In fact, just recently I’ve seen clients who didn’t want to see their usual primary care provider because they didn’t trust that their provider was helping them in ways they wanted to be helped.

In order for us to maintain trust and re-establish broken trust, we need to be aware of clients’ expectations of us. Below is a list of common assessments that may trigger clients to mistrust us:

  • Lack of accountability: that we do not take ownership of our decisions and actions
  • Unreliable: that we do not keep promises or follow through what we say we’re going to do
  • Incompetent: that we do not have the knowledge, skill or judgment to do what we say we’re going to do
  • Uncaring: that we do not prioritize someone else’s best interests when we act and make decisions
  • Inauthentic: that we do not practice our values and beliefs
  • Judgmental: that we have a critical point of view about someone’s appearance, needs, problems or behaviours
  • Dishonest: that we don’t tell the truth
  • Un-boundaried: that we are unclear about what is and what isn’t okay

Here’s a question to consider:

While preparing to administer an intramuscular injection to a young child, the practical nurse says “Don’t worry, it won’t hurt at all”. What component of the therapeutic relationship has the practical nurse violated?  

  1. Respect
  2. Trust
  3. Empathy
  4. Power 

Answer: 2.

Dishonesty breaks trust. When we lie or avoid (omit) sharing information with people, they are lead to believe that we may not be safe to trust. In other words, they may feel the need to protect themselves by not making vulnerable what’s important to them.

Telling the truth can be hard, especially when it may be difficult for someone to hear. But it turns out, most clients and family members want total honesty from us, even it means saying things people don’t want to hear.

In order for people to make informed decisions about their health and their care and be prepared for the outcomes of interventions and procedures, it’s often best to tell the truth.

Exam tactic

Trust is the foundation for our interactions with clients. When choosing answers on the CPNRE®, always remember our responsibility to tell the truth, to be reliable and to help clients feel safe and comfortable in sharing their problems with us. When clients trusts us, they’re healthier because of it – and we’re remembered for it.