Philosophical Perspectives on Trustworthiness and Open-mindedness as Professional Virtues for the Practice of Nursing: Implications for he Moral Education of Nurses

That patients should trust nurses and that nurses should be trustworthy are two ideas
generally held to be important in the practice of nursing. But why should this be so?
Why is trust important here? Surely all that is needed is that patients have confidence in
the systems of regulation for practising nurses? If patients can rely on the competence of
nurses why is there a need for anything else? The reassurance these things provide
allows one to know that when one becomes a patient one is in safe hands. Why isn’t this
enough? If trust and trustworthiness are so important, what is it that they add?

Given that the enterprise of health and social care is generally focussed on helping
individuals to maximise their potential for health (broadly defined) and given that
nursing practice requires interactions between nurses and patients, and that this
inevitably gives rise to (interpersonal relationships, then it is not unreasonable to locate
the discussion (at least in the first instance) in terms of personal trust. But first it is
necessary to take a brief historical view of the story of trust in health care.

The tradition of trust in health care

As with many aspects of nursing, the roots of the tradition of trust are to be found in
medicine. The necessity of trust for medical practice is articulated in the Hippocratic
Oath and, despite challenges to medical and professional domination of health care
provision, this remains a powerful influence on the view that patients should place their
trust in doctors and other health care professionals. Carlton sums this up when she says:
“Physicians believe that patients have an obligation to accept their recommendations for
treatment... Patients must trust their physicians as a condition of the therapeutic
enterprise” (Carlton 1978 p. 24) (emphasis added). What this tradition requires is that
doctors, and, by extension, other health care professionals (including nurses) act in the
best interests of patients, and this is part of what seems to be meant by trust in
professional-patient relationships. Quite what acting in a patient’s best interests actually
involves, and therefore what it is that health care professionals can be trusted with or to
do changes over time and remains a matter of debate, not only within and between
health care professionals but also between health care professionals on the one hand and
patients and the general public on the other. Medicine remains an inherently
conservative profession with entrenched hierarchical power relationships that tend to
militate against reform. For example, medicine, in the form of the British Medical
Association has a history of holding out against changes including objections to the
creation of the NHS, and, more recently, to proposed changes both to the consultant

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