dedicated work, there were failures on occasion in the care provided to very sick
children.
(Kennedy 2001 p. 1)
Thus it might be thought that good will alone is an insufficient condition for trust but
this would be to confuse good will with, for example, mere good intentions or
dedication. While these (and other) things may well be important aspects, there is yet
more to be said about quite what it is that a good will requires and we will come to this
in due course. For now we must continue with our account of the place of trust in the
practice of nursing.
Trust in nursing: personal or professional?
Despite her objections, O’Neill (2002) does nevertheless admit that good will may be
central in some, but not all, cases of personal trust. Assuming that it is generally
considered desirable that nurses have good will towards patients, and given that nursing
practice inevitably requires patients to reveal, willingly or not, intimate personal details
(details moreover that might not be revealed outside of a professional caring
relationship) then it would seem that even O’Neill must accept good will on the part of
the nurse as a desirable if not essential feature of the trust relationship between a nurse
and a patient, if only because the nurse-patient relationship cannot be regarded without
recognising that it contains at least some features of personal trust. As Baier notes it is
because we require the assistance of others in “... looking after the things we most
value ... [that] we have no choice but to allow some others to be in a position to harm
them” (Baier 1986 p. 236). In other words we cannot escape the need to trust at least
some others, and this must entail some aspects of personal trust. In contrast, Gilbert
argues that personal trust has no place in nursing. He says “The nature of trust
structured within nurse-client relations is a form of impersonal trust for it has no
commitment beyond the specific circumstances of the system ...” (Gilbert 1998 p.
1015). For Gilbert any talk of trust within nursing practice is merely one part of a
system of performance (what he calls ‘impression management’) for monitoring nursing
actions and for containing patient expectations. But in rejecting the possibility that
nurses can enter into a relationship with patients that contains at least some elements of
personal trust, Gilbert offers only an impoverished view of the potential for health care
practitioners to enhance the capacity of more-than-ordinarily vulnerable persons to
flourish. Given these two choices (which, by implication, reflect quite different
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