Joumal of Advanced Nurstng, 1992,17,1238-1242
Confidence as a factor in chronic illness care Kathenne Kirk RN CRRN MN Assistant Professor, College of Nursing, Umversity of Saskatchewan, Saskatoon, Saskatchewan, S7N OWO, Canada
Accepted for publication 17 February 1992
KIRK K (1992) journal of Advanced Nurstng 17,1238-1242 Confidence as a factor m chronic illness care Confidence is generally regarded as a positive quality which enhances personal coping and success For those who are chronically ill and face a life of uncertainty, confidence becomes especially important In a recent qualitative study examining chronically ill patients' perceptions of nursing care, confidence was found to be the grand essence which tied together all the informants' expenences with good nursing care The mformants entered the hospital with the expectation that the nurses would and could look after them Observing and receivmg good nursmg care reinforced this confidence In addition to this, the informants referred to confidence that was developed by the mterest and value the nurses placed on the patient as an individual Showing an interest m the patient as an mdividual gave the patient confidence in self-worth and m personal coping ability These two sources of confidence combined to give the informants confidence in their futures In the nursing literature the exploration of the concept of confidence is mmimal This paper discusses confidence as a factor m the care of the chronically ill using data from the study for illustration
CONFIDENCE AND CHRONIC ILLNESS Confidence is a widely used but poorly defined term CARE with a vanety of implied meamngs Webster (1990) defines Confidence is often descnbed m nursing hterature as a the term as 'full of trust' and 'self-reliance, assurance, posihve outcome of speafic nursing interventions but is or boldness' Roget's Thesaurus (1977) relates the word rarely defined or measured Studies suggest that an increase to other terms such as belief, equanimity, expectahon, in confidence enhances self-care efforts (Aitken & Kenny fearlessness, hope and sureness 1990, Barsevick & Johnson 1990) Confidence emerged as Peterson & Pitz (1988) m their study of confidence the grand essence, or theme, from the data m the qualitahve defined the concept as 'a person's belief that a previously study 'chronically ill pahents' percephons of nursing care' stated prediction is correct', thus equating it with (Kirk 1990) hypothesis (belieO evaluation Nursing authors such as This study, which explored rheumatic disease unit Gregg (1955) and Teasdale (1989) associate reassurance patients' expenence of nursing care, found that develop- with confidence Barsevick & Johnson (1990) measure conment and maintenance of confidence was the distinguishing fidence m terms of feelmg confident, eager, challenged, factor of 'good' nursing care Receiving care evaluated by interested or hopeful, and state that 'Information seeking the patient as good not only provided reassurance that the was assoaated with the positive emotional response, nurses would look after the patient, but also confirmed confidence' that the patient would be able to cope with the illness in Because informants m the study most commonly the future The role of confidence m the facihtation of refened to confidence m relation to the quahties of assursuccessful coping of chronically ill people is an important ance, trust and reassurance, the concept will be explored considerahon for nurses working with these patients usmg these words as a guide As can be expected m a 1238
Confidence and chrome illness
qualitative study, the data from individual mformants emphasized different aspects of the concept
ASSURANCE Assurance is defined by Teasdale (1989) as a promise, pledge or guarantee Webster (1990) defines assurance as 'a posihve declaration intended to give confidence', 'pledge or guarantee', 'certainty or sureness' and 'selfconfidence' These aspects of assurance for the chronically ill receivmg nursing care are discussed in the following section Informants in the study entered the hospital with the belief that nurses would look after them according to their needs This expectation was denved from two sources of assurance, the controls for the prachce of nursing and the image of Florence Nightittgale
Positive declaration The first source of the informants' expectation of nurses, the belief m the effectiveness of the controls extemal to the nurse, was expressed by one informant as Oh my God, the kids are running the place' But then I thought, well, they passed their courses and their RNs [hcensure examinations] so they must be OK And the head nurse there is very nice and very stnct, she runs a good place so I knew the kids must be OK This informant referred to three agencies upon which she relied to guarantee competent nursing care the educational institution, the professional licensing body, and the management of the employing institution The informants regarded themselves as deficient m the knowledge necessary to evaluate competent nursing care and were confident in the function of qualifications established by these agencies to ensure that the care received was safe, sblled and knowledgeable Graduation from an approved educational institution and achieving licensure to practise nursmg can be seen as posihve declarahons of competence intended to give the public confidence in whatever nursmg care they need This guaremtee is particuleirly significant m the context m which the data were gathered because, just pnor to the study, the title 'nurse' became protected by law for registered nurses only The informants made accurate distinctions between nurses, nursing assistants and other hecilth Ceire workers within the interview settings, relying upon the nursing management and administration of the agency to ensure care was given competently and safely by appropnately qualified personnel
Promise, pledge, guarantee The legacy of Miss Nightingale was expressed by the informants m terms of devotion to their care The informants inferred a promise or pledge of nurses m general to look after them, whatever their needs This mference was succinctly expressed in a conversahon with one mformant who stated that on this admission he did not require nursing care, he was only m hospital for medical diagnosis and treatment I suppose if I were more sick it would be a different story (Researcher) So, say you were more sick, what would they [the nurses] be doing for you? Looking after you Certainty or sureness Neither certainty nor sureness are concepts commonly associated with chronic ilbess The antonym, uncertainty, has been well documented in conjunction with the expenence of coping in chronic illnesses Peterson & Pitz (1988) define uncertainty as 'a person's beliefs about the vanability of possible outcomes (le how broad a range of outcomes is believed to be possible, and how diffusely distnbuted are the behefs over that range)' Mishel (1988) adds the need for meaning to the definition, and states that 'Uncertainty occurs in a situation m which the decision maker is unable to assign definite value to objects or events and/or is unable to predict outcomes accurately' Vanable and unpredictable outcomes are a daily expenence for many people with chronic illness, hindering preparation and planning for even routine events The informants m the study descnbed as good care nursing actions which increased certainty and faahtated their ability to prepare and plan These nursing achvihes were informational in nature, for example, telling the patient when tests and therapies were scheduled, and explaining procedures and medications Prepanng was important because it induded understanding 'what you have to face' Being uncertain left room to fear the worst The ability to plan for lUness-related schedules gave the informants some control m their lives they descnbed negative examples of 'just bemg grabbed from the bed for an X-ray or something', situahons which made them feel powerless, insignificant and unsure of what to expect Self-confidence Self-confidence, or self-assurance, m the nurse was an important factor in assurance 1239
K Kirk
It's hard, how do you descnbe competence? Self-assured or confidence, but how does a patient determine comf>etence? Self-assured leaves confidence with you We assume competence, I guess Those people, what do you call them that poke m your arms? (Researcher) Lab techs' Yes, lab techs 'Whoops whoops, I missed it' But if they're really assured and say they're sorry, you have confidence You feel it isn't just some httle kid poking away at you Like the nurse starting an l v If she tries and can't do it — if she says she s having trouble finding the vein and will get someone else to do it, you're more confident If a nurse showed self-assurance by acknowledging her limitations, errors were not as likely to be construed as incompetent by the informants As this informant put it 'I have confidence in her [the nurse] but I know there's the possibiLty of human failure' This informant's clanfymg
statement, that he was confident 'That I'll be looked after, that she'll follow the doctors' orders as she's supposed to and maybe go a bit further', related the feehng of confidence to the assurance by the individual nurse that the pledge of the profession would be adhered to
TRUST Webster's dichonary (1990) gives reciprocal definitions for confidence and tmst, demonstratmg that the words may be used interchangeably Trust in nursing relationships IS generally applied to the interpersonal aspects of confidence, 'Confidence m someone or something' (Meize-Grochowski 1984) KoUer (1988) defines trust as 'A person's expectation that an interachon partner is able and willmg to behave promotively toward the person' and hypothesizes that trust mcreases as the degree of nsk increases This defimtion of trust is illustrated by the informants' belief that the nurses would look after them in varying situations and conditions
while at the same time having to contend with the unpersonal approach of institutional scheduling and regulations Patients m this situation need to feel secure in the care of their pnmary caregivers, the nurses Promotive behaviour and risk The informants m the study referred to the positive expenence of feeling at home Home-like routines, such as having aftemoon tea or an evemng snack, were found to be comforting At home the informants knew the rules of mteraction necessary to obtain satisfaction of needs, while in the hospital they were afraid to 'impose' lest they be seen as demanding The fear descnbed above necessitated that the informants be able to rely on the nurses to anticipate their needs Some informants regarded the nurse as being similar to a mother 'She'll know what to do' KoUer's (1988) hypothesis that tmst mcreases as nsk increases explains this requirement As an intimate relationship is entered through dependency of one person upon another for physical or emotional care, the potential for harm, or nsk, increases Vulnerability is accentuated by the fact that the patient is in the nurses' territory, therefore the nurse has the advantage of knowledge and skill m the 'system' One informant tmsted that needs left unattended to by the nurse must be unimportant in the hospital As a result of this tmst she went uncomplaining, for 10 weeks, without having anyone offer to assist her with washing her hair, an activity she could not perform Beard (1982) states that tmst is a stable personality trait, but Meize-Grochowski (1984) and Thome & Robinson (1989) view tmst as fragile This apparent contradiction is resolved by Thome and Robinson's concept of naive tmst which IS the predisposition of people to tmst the health care system on first contact As people become intimately famihar with the system this trust is lost, eventually to be replaced by a more selective and participatory relationship, guarded alliance Expenence
Interpersonal relationships Relationships between nurses and the hospitalized chronically ill may be charactenzed by intimacy and familianty Intimacy is forced when the nurse must assume responsibility for counselling, personal care, treatments and test preparation Familianty results from lengthy and repeated admissions to the same umt or hospital The chronically ill patient may be m an ambiguous situahon, needing the mhmate and familiar relahonship with nurses 1240
The informants in the study leamed through expenence to tmst specific nurses in particular situations but not m others Some nurses were not tmsted to assist with dressing because they caused an excessive amount of pam Another nurse was not tmsted with information because she did not respect the informant's own expertise Other nurses were given confidences m the behef that they would interpret and convey these concems to the doctors on the patient's behalf These informants indicated that their tmst in the profession remained strong m spite
Confidence and chronic illness
of the shortcomings of speafic nurses The assurance provided by the profession may be strengthened by the patient's need to tmst when vulnerabihty from illness heightens the nsk m their relationships
REASSURANCE Reassurance is the final aspect of confidence to be discussed It is frequently found in nursing care plans as a psychosocial intervention to reduce anxiety and uncertainty Webster (1990) defines the word as 'to restore to confidence' Teasdale (1989) states that reassurance is both a process and an outcome A person may go through the process of reassunng without achieving the effect of reassurance m the intended reapient Empty reassurances such as 'Nothing could be that bad' (Gregg 1955), used to avoid an emotional scene, are an extreme example of an ineffective intervention Boyd & Munhall (1989) descnbe six positive outcomes of reassurance assisting the client to 1 2 3 4 5 6
identify options and feel influential, make decisions based on correct information, feel capable of enduring difficult times, take good care of themselves and comfort themselves, evaluate their responses in the context of 'normal', communicate effechvely and influence other's responses
These outcomes are consistent with Barsevick & Johnson's (1990) measurement cntena for confidence and are important factors in confidence for the chronically ill who face an unpredictable future Nurses most effectively reassure these patients that they are capable of coping with each development in their illness Informants stated that being infonned of what to expect from tests and procedures was important They could prepare by reassuring themselves that they were able to cope with each situation Self-assurance m the nurse's manner gave confidence m that nurse's competence Conveying respect Conveying respect for each individual reassured informants that the nurse was concemed about the welfare of every patient, and therefore would give care with that person's best mterest m mind Respect and interest m the informant shown by taking his or her 'experhse' and expenence senously attested to the personal worth of that individual and endorsed his or her own capabihhes and strengths Assishng the pahent to make mdependent choices and
achons by giving the necessary information and feedback also contnbuted to this effect
Gregg (1955) sums up the process and outcomes of reassurance m nursing care m this statement Reassurance is expenenced by a patient when hefindsthat he IS respected and understood by the nurse who assists him to recognize and develop his own resources and thereby restore his confidence in himself Regaining confidence in one's own coping skills reassured mformants about their future
CONCLUSION Receiving care characterized by respect for, and interest m themselves as persons, self-assurance, and informationgiving supported the assurances of the profession for competent care and gave the informants a good feeling about themselves and their care their tmst in the nurse was well-founded and they were encouraged about their own capabilities for the future It seems logical to assume that tmst m one's caregivers and confidence in one's own abilities would facilitate coping This assumption is supported by a study conducted by Grace & SchiU (1986) which found that subjects who scored high in tmst utihze their supports more effectively At a time when our society is expecting a significant increase m chronic illness, it seems expedient to pursue nursing studies in this area Because coping and health care relationships are lifetime requirements for individuals with chrome illness, approaches to their care which maximize coping effectiveness are of fundamental importance The mformants in this study have descnbed types of nursing care behaviours and interventions which have faahtated coping through giving confidence, but the nursing research-based literature m this area is sparse cuid requires more attention More research activity is needed to clanfy these concepts and their associations with coping effectiveness and specific nursmg interventions
References Aitken H A & Kenny GNC (1990) Use of patient controlled analgesia in postoperative cardiac surgical patients—a survey of ward staff attitudes Intensive Care Nursing 6, 74-78 Barsevick A M & Johnson J E (1990) Preference for infonnation and involvement, information seeking and emotional responses of women undergoing colposcopy Research in Nursing and Health 1 3 , 1 - 7
Beard MT (1982) Tmst, life events, and nsk factors among adults Advances in Nursing Science 4,16—43
1241
K Kirk Boyd C O & Munhall P L (1989) A qualitative mveshgation of reassurance Holistic Nursing Practice 4(1), 61-69 Grace G D & Schill T (1986) Social support and coping style differences in subjects high and low in interpersonal trust Psychological Reports 59, 584-586 Gregg D (1955) Reassurance The Amencan Joumal of Nursing 55,171-174 Kirk K L (1990) Chronically ill patients' perceptions of nursing care Unpubhshed master's thesis University of Saskatchewan, Saskatoon, Saskatchewan KoUerM (1988) Risk asa detenninant of trust Basic and Applied Social Psychology 9, 265-276 Meize-Grochowski R (19a4) An analysis of the concept of trust Joumal of Advanced Nursing 9, 563-572
1242
Mishel M H (1988) Uncertainty in illness Image Joumal of Nursing Scholarship 20, 225-232 Peterson DK & Pitz GF (1988) Confidence, uncertamty, and the use of information Joumal of Expenmental Psychology 14,
85-92 Roget's International Thesaurus 4th edn (1977) Fitzhenry and Whiteside, Toronto Teasdale K (1989) The concept of reassurance in nursing Joumal of Advanced Nursing 14, 444—450 Thome SE & Robmson C A (I9a9) Guarded alliance health care relationships in chronic illness Image Joumal of Nursing Scholarship 21,153-157 Webster's Desk Dictionary of the English Language (1990) Portland House, New York
Confidence as a factor in chronic illness care Kathenne Kirk RN CRRN MN Assistant Professor, College of Nursing, Umversity of Saskatchewan, Saskatoon, Saskatchewan, S7N OWO, Canada
Accepted for publication 17 February 1992
KIRK K (1992) journal of Advanced Nurstng 17,1238-1242 Confidence as a factor m chronic illness care Confidence is generally regarded as a positive quality which enhances personal coping and success For those who are chronically ill and face a life of uncertainty, confidence becomes especially important In a recent qualitative study examining chronically ill patients' perceptions of nursing care, confidence was found to be the grand essence which tied together all the informants' expenences with good nursing care The mformants entered the hospital with the expectation that the nurses would and could look after them Observing and receivmg good nursmg care reinforced this confidence In addition to this, the informants referred to confidence that was developed by the mterest and value the nurses placed on the patient as an individual Showing an interest m the patient as an mdividual gave the patient confidence in self-worth and m personal coping ability These two sources of confidence combined to give the informants confidence in their futures In the nursing literature the exploration of the concept of confidence is mmimal This paper discusses confidence as a factor m the care of the chronically ill using data from the study for illustration
CONFIDENCE AND CHRONIC ILLNESS Confidence is a widely used but poorly defined term CARE with a vanety of implied meamngs Webster (1990) defines Confidence is often descnbed m nursing hterature as a the term as 'full of trust' and 'self-reliance, assurance, posihve outcome of speafic nursing interventions but is or boldness' Roget's Thesaurus (1977) relates the word rarely defined or measured Studies suggest that an increase to other terms such as belief, equanimity, expectahon, in confidence enhances self-care efforts (Aitken & Kenny fearlessness, hope and sureness 1990, Barsevick & Johnson 1990) Confidence emerged as Peterson & Pitz (1988) m their study of confidence the grand essence, or theme, from the data m the qualitahve defined the concept as 'a person's belief that a previously study 'chronically ill pahents' percephons of nursing care' stated prediction is correct', thus equating it with (Kirk 1990) hypothesis (belieO evaluation Nursing authors such as This study, which explored rheumatic disease unit Gregg (1955) and Teasdale (1989) associate reassurance patients' expenence of nursing care, found that develop- with confidence Barsevick & Johnson (1990) measure conment and maintenance of confidence was the distinguishing fidence m terms of feelmg confident, eager, challenged, factor of 'good' nursing care Receiving care evaluated by interested or hopeful, and state that 'Information seeking the patient as good not only provided reassurance that the was assoaated with the positive emotional response, nurses would look after the patient, but also confirmed confidence' that the patient would be able to cope with the illness in Because informants m the study most commonly the future The role of confidence m the facihtation of refened to confidence m relation to the quahties of assursuccessful coping of chronically ill people is an important ance, trust and reassurance, the concept will be explored considerahon for nurses working with these patients usmg these words as a guide As can be expected m a 1238
Confidence and chrome illness
qualitative study, the data from individual mformants emphasized different aspects of the concept
ASSURANCE Assurance is defined by Teasdale (1989) as a promise, pledge or guarantee Webster (1990) defines assurance as 'a posihve declaration intended to give confidence', 'pledge or guarantee', 'certainty or sureness' and 'selfconfidence' These aspects of assurance for the chronically ill receivmg nursing care are discussed in the following section Informants in the study entered the hospital with the belief that nurses would look after them according to their needs This expectation was denved from two sources of assurance, the controls for the prachce of nursing and the image of Florence Nightittgale
Positive declaration The first source of the informants' expectation of nurses, the belief m the effectiveness of the controls extemal to the nurse, was expressed by one informant as Oh my God, the kids are running the place' But then I thought, well, they passed their courses and their RNs [hcensure examinations] so they must be OK And the head nurse there is very nice and very stnct, she runs a good place so I knew the kids must be OK This informant referred to three agencies upon which she relied to guarantee competent nursing care the educational institution, the professional licensing body, and the management of the employing institution The informants regarded themselves as deficient m the knowledge necessary to evaluate competent nursing care and were confident in the function of qualifications established by these agencies to ensure that the care received was safe, sblled and knowledgeable Graduation from an approved educational institution and achieving licensure to practise nursmg can be seen as posihve declarahons of competence intended to give the public confidence in whatever nursmg care they need This guaremtee is particuleirly significant m the context m which the data were gathered because, just pnor to the study, the title 'nurse' became protected by law for registered nurses only The informants made accurate distinctions between nurses, nursing assistants and other hecilth Ceire workers within the interview settings, relying upon the nursing management and administration of the agency to ensure care was given competently and safely by appropnately qualified personnel
Promise, pledge, guarantee The legacy of Miss Nightingale was expressed by the informants m terms of devotion to their care The informants inferred a promise or pledge of nurses m general to look after them, whatever their needs This mference was succinctly expressed in a conversahon with one mformant who stated that on this admission he did not require nursing care, he was only m hospital for medical diagnosis and treatment I suppose if I were more sick it would be a different story (Researcher) So, say you were more sick, what would they [the nurses] be doing for you? Looking after you Certainty or sureness Neither certainty nor sureness are concepts commonly associated with chronic ilbess The antonym, uncertainty, has been well documented in conjunction with the expenence of coping in chronic illnesses Peterson & Pitz (1988) define uncertainty as 'a person's beliefs about the vanability of possible outcomes (le how broad a range of outcomes is believed to be possible, and how diffusely distnbuted are the behefs over that range)' Mishel (1988) adds the need for meaning to the definition, and states that 'Uncertainty occurs in a situation m which the decision maker is unable to assign definite value to objects or events and/or is unable to predict outcomes accurately' Vanable and unpredictable outcomes are a daily expenence for many people with chronic illness, hindering preparation and planning for even routine events The informants m the study descnbed as good care nursing actions which increased certainty and faahtated their ability to prepare and plan These nursing achvihes were informational in nature, for example, telling the patient when tests and therapies were scheduled, and explaining procedures and medications Prepanng was important because it induded understanding 'what you have to face' Being uncertain left room to fear the worst The ability to plan for lUness-related schedules gave the informants some control m their lives they descnbed negative examples of 'just bemg grabbed from the bed for an X-ray or something', situahons which made them feel powerless, insignificant and unsure of what to expect Self-confidence Self-confidence, or self-assurance, m the nurse was an important factor in assurance 1239
K Kirk
It's hard, how do you descnbe competence? Self-assured or confidence, but how does a patient determine comf>etence? Self-assured leaves confidence with you We assume competence, I guess Those people, what do you call them that poke m your arms? (Researcher) Lab techs' Yes, lab techs 'Whoops whoops, I missed it' But if they're really assured and say they're sorry, you have confidence You feel it isn't just some httle kid poking away at you Like the nurse starting an l v If she tries and can't do it — if she says she s having trouble finding the vein and will get someone else to do it, you're more confident If a nurse showed self-assurance by acknowledging her limitations, errors were not as likely to be construed as incompetent by the informants As this informant put it 'I have confidence in her [the nurse] but I know there's the possibiLty of human failure' This informant's clanfymg
statement, that he was confident 'That I'll be looked after, that she'll follow the doctors' orders as she's supposed to and maybe go a bit further', related the feehng of confidence to the assurance by the individual nurse that the pledge of the profession would be adhered to
TRUST Webster's dichonary (1990) gives reciprocal definitions for confidence and tmst, demonstratmg that the words may be used interchangeably Trust in nursing relationships IS generally applied to the interpersonal aspects of confidence, 'Confidence m someone or something' (Meize-Grochowski 1984) KoUer (1988) defines trust as 'A person's expectation that an interachon partner is able and willmg to behave promotively toward the person' and hypothesizes that trust mcreases as the degree of nsk increases This defimtion of trust is illustrated by the informants' belief that the nurses would look after them in varying situations and conditions
while at the same time having to contend with the unpersonal approach of institutional scheduling and regulations Patients m this situation need to feel secure in the care of their pnmary caregivers, the nurses Promotive behaviour and risk The informants m the study referred to the positive expenence of feeling at home Home-like routines, such as having aftemoon tea or an evemng snack, were found to be comforting At home the informants knew the rules of mteraction necessary to obtain satisfaction of needs, while in the hospital they were afraid to 'impose' lest they be seen as demanding The fear descnbed above necessitated that the informants be able to rely on the nurses to anticipate their needs Some informants regarded the nurse as being similar to a mother 'She'll know what to do' KoUer's (1988) hypothesis that tmst mcreases as nsk increases explains this requirement As an intimate relationship is entered through dependency of one person upon another for physical or emotional care, the potential for harm, or nsk, increases Vulnerability is accentuated by the fact that the patient is in the nurses' territory, therefore the nurse has the advantage of knowledge and skill m the 'system' One informant tmsted that needs left unattended to by the nurse must be unimportant in the hospital As a result of this tmst she went uncomplaining, for 10 weeks, without having anyone offer to assist her with washing her hair, an activity she could not perform Beard (1982) states that tmst is a stable personality trait, but Meize-Grochowski (1984) and Thome & Robinson (1989) view tmst as fragile This apparent contradiction is resolved by Thome and Robinson's concept of naive tmst which IS the predisposition of people to tmst the health care system on first contact As people become intimately famihar with the system this trust is lost, eventually to be replaced by a more selective and participatory relationship, guarded alliance Expenence
Interpersonal relationships Relationships between nurses and the hospitalized chronically ill may be charactenzed by intimacy and familianty Intimacy is forced when the nurse must assume responsibility for counselling, personal care, treatments and test preparation Familianty results from lengthy and repeated admissions to the same umt or hospital The chronically ill patient may be m an ambiguous situahon, needing the mhmate and familiar relahonship with nurses 1240
The informants in the study leamed through expenence to tmst specific nurses in particular situations but not m others Some nurses were not tmsted to assist with dressing because they caused an excessive amount of pam Another nurse was not tmsted with information because she did not respect the informant's own expertise Other nurses were given confidences m the behef that they would interpret and convey these concems to the doctors on the patient's behalf These informants indicated that their tmst in the profession remained strong m spite
Confidence and chronic illness
of the shortcomings of speafic nurses The assurance provided by the profession may be strengthened by the patient's need to tmst when vulnerabihty from illness heightens the nsk m their relationships
REASSURANCE Reassurance is the final aspect of confidence to be discussed It is frequently found in nursing care plans as a psychosocial intervention to reduce anxiety and uncertainty Webster (1990) defines the word as 'to restore to confidence' Teasdale (1989) states that reassurance is both a process and an outcome A person may go through the process of reassunng without achieving the effect of reassurance m the intended reapient Empty reassurances such as 'Nothing could be that bad' (Gregg 1955), used to avoid an emotional scene, are an extreme example of an ineffective intervention Boyd & Munhall (1989) descnbe six positive outcomes of reassurance assisting the client to 1 2 3 4 5 6
identify options and feel influential, make decisions based on correct information, feel capable of enduring difficult times, take good care of themselves and comfort themselves, evaluate their responses in the context of 'normal', communicate effechvely and influence other's responses
These outcomes are consistent with Barsevick & Johnson's (1990) measurement cntena for confidence and are important factors in confidence for the chronically ill who face an unpredictable future Nurses most effectively reassure these patients that they are capable of coping with each development in their illness Informants stated that being infonned of what to expect from tests and procedures was important They could prepare by reassuring themselves that they were able to cope with each situation Self-assurance m the nurse's manner gave confidence m that nurse's competence Conveying respect Conveying respect for each individual reassured informants that the nurse was concemed about the welfare of every patient, and therefore would give care with that person's best mterest m mind Respect and interest m the informant shown by taking his or her 'experhse' and expenence senously attested to the personal worth of that individual and endorsed his or her own capabihhes and strengths Assishng the pahent to make mdependent choices and
achons by giving the necessary information and feedback also contnbuted to this effect
Gregg (1955) sums up the process and outcomes of reassurance m nursing care m this statement Reassurance is expenenced by a patient when hefindsthat he IS respected and understood by the nurse who assists him to recognize and develop his own resources and thereby restore his confidence in himself Regaining confidence in one's own coping skills reassured mformants about their future
CONCLUSION Receiving care characterized by respect for, and interest m themselves as persons, self-assurance, and informationgiving supported the assurances of the profession for competent care and gave the informants a good feeling about themselves and their care their tmst in the nurse was well-founded and they were encouraged about their own capabilities for the future It seems logical to assume that tmst m one's caregivers and confidence in one's own abilities would facilitate coping This assumption is supported by a study conducted by Grace & SchiU (1986) which found that subjects who scored high in tmst utihze their supports more effectively At a time when our society is expecting a significant increase m chronic illness, it seems expedient to pursue nursing studies in this area Because coping and health care relationships are lifetime requirements for individuals with chrome illness, approaches to their care which maximize coping effectiveness are of fundamental importance The mformants in this study have descnbed types of nursing care behaviours and interventions which have faahtated coping through giving confidence, but the nursing research-based literature m this area is sparse cuid requires more attention More research activity is needed to clanfy these concepts and their associations with coping effectiveness and specific nursmg interventions
References Aitken H A & Kenny GNC (1990) Use of patient controlled analgesia in postoperative cardiac surgical patients—a survey of ward staff attitudes Intensive Care Nursing 6, 74-78 Barsevick A M & Johnson J E (1990) Preference for infonnation and involvement, information seeking and emotional responses of women undergoing colposcopy Research in Nursing and Health 1 3 , 1 - 7
Beard MT (1982) Tmst, life events, and nsk factors among adults Advances in Nursing Science 4,16—43
1241
K Kirk Boyd C O & Munhall P L (1989) A qualitative mveshgation of reassurance Holistic Nursing Practice 4(1), 61-69 Grace G D & Schill T (1986) Social support and coping style differences in subjects high and low in interpersonal trust Psychological Reports 59, 584-586 Gregg D (1955) Reassurance The Amencan Joumal of Nursing 55,171-174 Kirk K L (1990) Chronically ill patients' perceptions of nursing care Unpubhshed master's thesis University of Saskatchewan, Saskatoon, Saskatchewan KoUerM (1988) Risk asa detenninant of trust Basic and Applied Social Psychology 9, 265-276 Meize-Grochowski R (19a4) An analysis of the concept of trust Joumal of Advanced Nursing 9, 563-572
1242
Mishel M H (1988) Uncertainty in illness Image Joumal of Nursing Scholarship 20, 225-232 Peterson DK & Pitz GF (1988) Confidence, uncertamty, and the use of information Joumal of Expenmental Psychology 14,
85-92 Roget's International Thesaurus 4th edn (1977) Fitzhenry and Whiteside, Toronto Teasdale K (1989) The concept of reassurance in nursing Joumal of Advanced Nursing 14, 444—450 Thome SE & Robmson C A (I9a9) Guarded alliance health care relationships in chronic illness Image Joumal of Nursing Scholarship 21,153-157 Webster's Desk Dictionary of the English Language (1990) Portland House, New York
