title: Application of the Reina Trust and Betrayal Model to the experience of pediatric critical care clinicians.
abstract: BACKGROUND
  Trust is essential in the workplace, yet no systematic studies of trust among pediatric critical care professionals have been done.
  
  
  OBJECTIVE
  To determine the feasibility of measuring trust in a pediatric intensive care unit by using established scales from the corporate world and to determine what behaviors build, break, and rebuild trust.
  
  
  METHODS
  The Reina Trust and Betrayal Model was used to explore contractual, competence, and communication trust. Nurses and physicians in a pediatric intensive care unit completed online surveys to measure organizational, team, and patient trust. Quantitative data from 3 standard survey instruments and qualitative responses to 3 open-ended questions were analyzed and compared.
  
  
  RESULTS
  Quantitative data from all 3 instruments indicated moderate to high levels of trust; scores for competence and contractual trust were higher than scores for communication trust. Scores indicated agreement on behaviors that build trust, such as pointing out risky situations to each other, actively striving to build supportive and productive relationships, and giving and receiving constructive feedback. Foremost among trust-breaking behaviors was gossip, which was more troublesome to respondents with longer experience in critical care. Responses to the open-ended questions underscored these themes. The most frequently cited items included encouraging mutually serving intentions, sharing information, and involving and seeking the input of others.
  
  
  CONCLUSIONS
  The Reina trust scales and open-ended questions are feasible and applicable to pediatric critical care units, and data collected with these instruments are useful in determining what behaviors build, break, and rebuild trust among staff.
authors.affiliation: Johns Hopkins University, Berman Institute of Bioethics in Baltimore, Maryland, USA. crushton@son.jhmi.edu
authors.forename: Cynda Hylton
authors.initials: CH
authors.lastname: Rushton
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Reina
authors.forename: Christopher
authors.initials: C
authors.lastname: Francovich
authors.forename: Phyllis
authors.initials: P
authors.lastname: Naumann
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Reina
mesh_terms: D002983:Clinical Competence; D003142:Communication; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008505:Medical Staff, Hospital / Q000523:psychology*; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010348:Patient Care Team; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D035502:Trust