3 Key Transactional Trusts a Chaplain Builds

Last week I had the opportunity to read an article in AACN Advanced Critical Care, Volume 18, Number 1, pp.19–30 © 2007, AACN, that had to do with the The Reina Trust & Betrayal Model. This article used as its focus “a difficult case study involving repeated health crises and irreversible organ dysfunction [that] illustrates the challenges critical care professionals face in caring for patients and their families. In such cases, trust is especially fragile, and coexists with its counterpart, betrayal. The Reina Trust & Betrayal Model defines 3 types of Transactional Trust. The first, Competence Trust, or the Trust of Capability, requires that clinicians practice humility, engage in inquiry, honor the patient’s choices, and express compassion. The second, Contractual Trust, or the Trust of Character, demands that clinicians keep agreements, manage expectations, establish boundaries, and encourage mutually serving expectations. The third, Communication Trust, or the Trust of Disclosure, must be rooted in respect and based on truth-telling. Particularly in life-and death situations, communication requires honesty and clarity. Each type of trust involves specific behaviors that build trust and can guide critical care professionals as they interact with patients and their families. In reading this article with its case study I came to the conclusion that the three types of transactional trust fit what a hospice Chaplain does in his/her relationship with a patient and family. In hospice, every patient is in a health care crisis and, indeed, trust is fragile. The first and most important task of the Chaplain is to win and build trust with the patient and family. This illustrates the Competence Trust. By nature a Chaplain conveys humility, honors the patient’s choices, and expresses compassion. When a Chaplain’s competence is established in the relationship, a bond of trust, though newly established, begins to form. The next transactional trust is that of Contractual Trust. The relationship can crumble: 1. If the Chaplain cannot keep agreements (is late for appointments, does not call to reschedule, forgets names of patient and family members, is cold and aloof, for examples); 2. If the Chaplain tramples on boundaries by trying to rush the conversation toward converting the patient or violates confidentiality. The third trust is the Communication Trust. While the Chaplain will not deal with the medical side of the patient’s experience, it is absolutely fundamental that the Chaplain will respect the patient’s autonomy. I urge the reader to look for this article and superimpose upon it the role of the hospice Chaplain. Friends, you are a clinician and hold a revered place on the IDT. Blessings, Chaplains, for your work!