Establishing and maintaining trust during acute care hospitalizations.

The concept of trust is significant in nursing; however, it remains inadequately defined and operationalized. The purpose of this study was to advance the development of the concept of trust by exploring patients' perspectives of processes of establishing and maintaining trust in health care providers during acute care hospitalizations. Grounded theory methods, including theoretical sampling and the constant comparative processes, were used. The sample included 50 adult inpatients with a wide variety of medical-surgical diagnoses who discussed their experiences while hospitalized. The core variable linking the process of developing and maintaining trust was meeting expectations. Through a series of interactions with health care providers and other hospital personnel, patients used monitoring behaviors to evaluate congruency between their expectations of care and the actual behaviors of providers. From this evaluation, three trajectories were identified based on whether expectations were met, exceeded, or unmet. Trust was shown to be dynamic and thus permits opportunities for interventions to redirect the trajectory.