Inspiring Hope in Critical Care: The Role of Patients' Trust in Nurses

BACKGROUND: Hope among patients in intensive care units (ICU) supports a 'will to live' and recovery, yet it remains under-investigated. AIM: To explore ICU patients' experiences of trust in nurses and how they are linked to hope during and following ICU stays. STUDY DESIGN: A longitudinal narrative study guided by a constructivist paradigm, focusing on patients' meaning-making and interpretations of their lived experiences. Participants were three women and six men, aged 62-81, with life-threatening events and prolonged ICU stays. Each participant was interviewed upon discharge and again approximately 1 month later. Participants were recruited through snowball sampling. Inclusion criteria included prolonged ICU stays and willingness to participate. Data were analysed using reflexive thematic analysis. FINDINGS: Participants described both compassionate nursing care characterized by emotional presence and sustained efforts to relieve suffering and experiences of direct or indirect nurse aggression. Four states of trust were identified along a continuum ranging from trust to relying on personal agency and self-efficacy. Incidents of humiliation undermined dignity and weakened patients' capacity to trust. Hope emerged as a relational process closely associated with trust in nurses. Levi's profiles of hope were subsequently used as an interpretive framework for understanding variations in patients' experiences of hope. CONCLUSIONS: Trust is a relational process that unfolds within ICU nurse-patient interactions. Participants who described trusting relationships with nurses were more likely to report experiences consistent with hope during and following ICU hospitalization. Nurses play a central role in fostering trust and supporting hope during critical illness. RELEVANCE TO CLINICAL PRACTICE: The findings highlight the importance of nurse training targeting trust-building nursing practices to support hope among ICU patients. Attention to communication and emotional presence may strengthen therapeutic relationships, establish trust and inspire hope.