perspectives of the nature of nursing) it would be surprising if most individuals did not
wish nurse-patient relationships to approximate personal rather than impersonal trust.
Personal trust relationships: friendship
The paradigm case of personal trust is often taken to be friendship, and while
friendships and nurse-patient relationships are different, both require elements of
personal forms of trust if either is to be anything more than mere impersonal business-
like relationships. Friendship is generally considered to be a relationship that one freely
chooses to enter and one in which trust develops over time to become a feature that
defines the relationship as a friendship (although it should be apparent that there are
different levels of friendship implying varying degrees of trust). Clearly, whatever the
nurse-patient relationship is and however it develops, it does not share common origins
with friendships for, generally speaking and at the point of first contact, patients do not
freely choose to enter relationships with individual nurses. So it might seem from the
outset that the project to locate such relationships in terms of personal trust has already
run into serious difficulties. But while it is true that the nature of the relationship
between patient and nurse is different from friendship it nevertheless remains the case
that, except in rare instances, interactions between patients and nurses are, by their very
nature, at least personal and sometimes intimate. Thus at this point it is with ideas of
personal trust in mind that the inquiry proceeds.
De Reave (2002) responds to a criticism advanced by, among others, MacIntyre that
professionals (and by implication nurses) can only ever be inauthentic in their
relationships with patients. This is to say that because professionals must necessarily
modify their emotional responses they cannot lay claim to a genuine relationship with
patients. Professionals can never respond only in the way that, for example, a friend can
for this would be to compromise the professional-patient relationship. MacIntyre says:
Sometimes ... social workers are taught to become ‘friends’ with their clients in
order to gain their confidence so as to manipulate them more effectively. Now it
is of the essence of friendship as a virtue that one cannot become a friend from
such a motive and with such an intention.
(MacIntyre 1975 p. 106)
By extension, de Raeve argues that nurses must respond to the charge that any trust
relationship with a patient is founded on an untrustworthy and inauthentic premise of
‘fake’ interest in the well-being of that patient. De Raeve points out that to characterise
the nurse patient relationship as inauthentic on such grounds is to fail to recognise the
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