Lois Rajcan, MSN, RN, CRNI
A theoretical model developed to instill trust in nurses proposes that generating and promoting nurse trust requires identification of interventions which promote nursing care quality, individuality and patients’ health status.1
The concept of trust is defined as “the confidence that care would be appropriate, reliable, and as successful as possible.”2
Patients who trust their nurses believe that nurses will protect them from harm, provide reliable assistance when needed, and be honest during interactions.2
According to 2007 estimates, Americans lived with inserted central vascular access devices for 168,113,488 days.3
One type of these is the totally implantable vascular access device (TIVAD) or port. The first TIVAD was inserted in 1982 and, since then, has been considered a safe alternative to peripheral intravenous lines for administering chemotherapy infusions to oncology patients.4,5
Subsequently, the use of TIVADs has increased in the oncology population.5
Research has shown that pain and anxiety are related to port access.6
However, a need exists to capture patients’ feelings and emotions related to living with a port, as well as effective nursing interventions aimed to address those patient experiences.
A recent pilot study examined patients’ perspectives to help nurses tailor strategies to assist patients in coping with procedures related to caring for the TIVAD. Qualitative interpretive phenomenology was chosen to conduct and explore the meaning of oncology patients’ perspectives of living with a TIVAD.7,8
Some examples of the semistructured interview questions used in this study: “Can you tell me what the port means to you?” “What actions by the nurse make it easier to live with the port?” “How would you improve care of your port?” Institutional Review Board approval was obtained from Duquesne University in Pittsburgh, Pennsylvania, and Penn Medicine’s Chester County Hospital in West Chester, Pennsylvania, to interview oncology patients undergoing active chemotherapy treatment using a TIVAD.
Three participants were interviewed for this pilot study, and data were transcribed and analyzed using qualitative software. The data were read, coded, and categorized into common themes. Interview analysis revealed 16 topics that were combined into 9 themes supported by verbatim patient statements: (1) advantages of the port, (2) complications, (3) disadvantages of port, (4) discomfort, (5) emotion, (6) human contact, (7) nurse knowledge of port care, (8) strategies used by patient to make life easier, and (9) trust of care provider. Due to the pilot nature of this study, data saturation was not achieved. The theme, trust of care provider, emerged prominently from all 3 participants. Participant 1 best illustrated the need to have trust in the care provider: “If you have good professional advice, you will be fine; you need good professional advice. These nurses have been unbelievable, and I trust them [implicitly].”
However, trust placed in the nurse may not be unquestionably acquired by the patient based solely on the need for nursing care, as explained by participants 2 and 3:
“I would much rather a nurse tell me honestly that they are not comfortable accessing my port than attempt to access the port and cause an infection or pain.”
“I don’t want them [home care nurses] accessing my port unless they know how to do sterile technique. I know immediately when they put on their gloves if they know sterile technique in accessing my port.”
Participant 3 talked about the uniqueness and fragility of trust in the nurse by the patient: “I will call [the home infusion company] and say, ‘So-and-so [nurse] doesn’t have good sterile technique. I don’t want them back here [in my home] unless they learn how to use sterile technique.”
Without the presence of trust in a nurse, negative outcomes can occur, such as not feeling safe in the healthcare environment and agreeing to accept essential treatments and procedures.9
Participant 2 described feeling uncomfortable with the lack of expertise exhibited by a particular radiology nurse: “I try to make appointments for [CAT scans] when she is not there working. If she is working, I will reschedule my appointment for another day and time. I know she is not an oncology nurse, but if she works in this department, she should be able to access my port.” The TIVAD was more than a means to provide access to deliver chemotherapy to a patient. The TIVAD was also viewed as an object of vulnerability for the patient. “If you are going to access the port, access it properly because I am the one who pays the consequences if they [nurses] don’t,” said participant 3.
In a concept analysis of nurse–patient trust, Bell and Duffy (2009) proposed that patients assume certain attributes demonstrated by the nurse that convey this trust. These attributes include nurse clinical competency, goodwill, and understanding patient vulnerability related to the risks involved with caring for a patient.10
The comments related to nurse trust that were expressed by patients in this pilot study reflected attributes of honesty, clinical competency, and acknowledgement by the nurse regarding the vulnerability of the patient.
In summary, this pilot study suggests that a deeper meaning exists between the nurse and the patient when the patient’s TIVAD is accessed. Further exploration into the trust that patients have in nurses who care for their TIVADs can inform nurses about implementing quality patient-centered nursing interventions that promote positive health outcomes. Such outcomes aim to ensure that oncology patients accept their treatment, feel safe in the healthcare environment, effectively manage their disease processes, and achieve optimal wellness.
Lois Rajcan, MSN, RN, CRNI is working toward a PhD in nursing at Duquesne University in Pittsburgh, Pennsylvania.
- Charalambous A, Radwin LE, Berg A, et al. An international study of hospitalized cancer patients’ health status, nursing care quality, perceived individuality in care and trust in nurses: a path analysis. Int J Nurse Stud. 2016;61:176-186. doi: 10.1016/j.ijnurstu.2016.06.013.
- Radwin L, Alster K. Outcomes of perceived quality nursing care reported by oncology patients. Sch Inq Nurs Pract. 1999;13(4):327-343; discussion 345-347.
- Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. 2011;60(8):243-248.
- Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery. 1982;92(4):706-712.
- Singh KR, Agarwal G, Nanda G, et al. Morbidity of chemotherapy administration and satisfaction in breast cancer patients: a comparative study of totally implantable venous access device (TIVAD) versus peripheral venous access usage. World J Surg. 2014;38(5):1084-1092. doi: 10.1007/s00268-013-2378-x.
- Goossens GA, Vrebos M, Stas M, De Wever I, Frederickx L. Central vascular access devices in oncology and hematology considered from a different point of view: how do patients experience their vascular access ports? J Infus Nurs. 2005;28(1):61-67.
- Reiners GM. Understanding the differences between Husserl’s (descriptive) and Heidegger’s (interpretive) phenomenological research. J Nurs Care. 2012;1:119. doi: 10.4172/2167-1168.1000119.
- Rajcan L, Zoucha R, Goodfellow L. The lived experience of a person with a subcutaneous vascular access port: a mini-study. Poster presented at: Infusion Nurses Society National Convention; May 6-9, 2017; Minneapolis, MN.
- Mollon D. Feeling safe during an inpatient hospitalization: a concept analysis. J Adv Nurs. 2014;70(8):1727-1737. doi: 10.1111/jan.12348.
- Bell L, Duffy A. A concept analysis of nurse-patient trust. Br J Nurs. 2009;18(1):46-51.