Lying to Patients. Is it for the Best?

[bluemoon28]

I have worked as a labor and delivery nurse for 3 years and at 2 different hospitals. Yet one thing that seems to be the same is the lying or ommiting of information when it somes to the fetal heart rate tracing. Now I'm not talking about completely omitting all information about a bad tracing especially if you think your pt may end up in the OR for a c-section. I'm refering to minor lates, a variable here and there, or or simply a sleepy cycle of minimal variability that's lasted a little too long. So most nurses (this is what I was taught to do) will just come up with excuses for minor interventions. Like if the pt needs to be on her side they might say they've been in the same position for too long, or even ask if the pt wants to change position making it seem like it was their idea. I've also seen nurses say that they're worried the pt may be dehydrated so they can give a bolus. If the strip starts to get really bad of course they will tell the pt. I have even had doctor's get after me when they find out I told the pt they were having decels. Now I can see the pros and cons of borh sides. On one hand you want the pt to be informed and know what is going on in their care. On the other hand if you're strip really isn't that bad or if you just want to see some acels before placing cytotec or starting pit. It can really cause some problems in the room. Pts get anxious and worried, mhr goes up, pts already here for high bps have their blood pressures go up to unsafe levels, all over something that I wasn't really that worried about to begin with. However the worst part is not the pt but rather the family members that can start yelling at you about it, or start demanding a c-section. Some pts family members have even gotten combative in the past. Now I know why they can act this way there is a lot of stress and worry that goes into l&d and so many expectations, or previous bad outcome (stillbirth,miscarriages, baby in NICU, a friend of a cousin who end up mentally handicapped due to something at birth). Now I had tried to explain the fh tracing to family member and sometimes it helps but more often then not it just raises more questions and leaves you practically trying to give an intermediate fm class in the room. I know most nurses response to family members watching the tracing like a hawk is to tell them that it is the nurses job to watch the tracing.

Is this the right way to go? I don't want to worry new parents and family members especially if what is going on is not major, because it just leaves them anxious instead of enjoying the beautiful experience. Most pts especially inductions (which we do a lot of) will have some form of decel before they deliver, and a good chunk of them will deliver lady partslly without complications.

So I ask is this common in a lot of hospitals? Where do you draw the line of what to tell parents. If the issue is minor and easily corrected is it worth omitting information to keep the parents piece of mind if you can?

Now please understand that this omitting of information does not mean all information is omitted. Is the problem is very severe or the pt needs oxygen, or the doctors is being called, or it seems like we might be headed for a c-section then definitely all the nurses would make sure the pt is well informed.

I would really like to hear peoples opinion on this and what is common at other hospitals as I have only work at 2 and they both have done this with full encouragement of the doctors.

[kirsnikity]

I do not try to explain FHR tracings to families and patients, unless I have a situation where repetitive lates or variables are becoming a problem, or a prolonged decel happens. If they press me, I gently explain it takes a lot of practice and training to interpret monitor strips and can't be learned in a five minute session from me. Their response to this will depend a lot on how well trust has been established.

If I'm the admitting nurse (or at the beginning of my shift if I'm not), I take time to explain that baby's heart rates will occasionally fluctuate in labor, and I might come in to ask her to reposition or place some oxygen. I tell them that 99% of the time this is our normal practice and does not mean an emergency is happening. This seems to reduce a lot of fear/anxiety if I do have to do those things.

[hexoptic]

I always explain why I'm doing things, I don't make a huge deal of it if it's not much. May just say, you baby's heartbeat could look a little better (then explain what I'm seeing & what I'm doing to correct it). I will usually say, "I feel your baby is fine, at this time, if however, this changes I promise I will tell you and not keep you in the dark. They have the right to know.

Some people will follow carefully what you do, others will just tell you to do what you gotta do.

[quazar]

I guess I am guilty of lying to patients if you count lying by omission. In that I don't tell them, "your baby is having xyz decel, which means xyz, which means we need to do xyz intervention." I actually did do that when I was a newer L&D nurse way back in the day, but learned very quickly to not do it because yes, it freaked patients out, to be honest.

People have very selective memories in stressful situations, and filter out a lot of what they are hearing when under extreme stress. Labor and birth, for most people, is VERY stressful, and their memories of it are really skewed. If something they perceive as "bad" happens, that sticks in their mind and they grab onto that and focus on it, even years later. The same with something they perceive as exceptionally "good" happening. It stays with them. For this reason, I try to really minimize any sort of stress inducing communications with my patients at the bedside. Especially with a first time mom. My poker face is well honed now, as is my "calm voice," and those things have served me well when the poo is hitting the fan and I am screaming in my head but trying to not freak out the patient.

So I guess what I'm saying is, yeah, I kind of lie by omission in that I don't really get into the nitty gritty details of the fhr tracing unless I need to do a major intervention like knee chest, trendelenburg, hold up a cord prolapse, or run for a crash c-section. If the tracing is worsening and I can read the writing on the walls, I will calmly let the patient know bit by bit that there are some concerns, and explain as gently as possible what it happening and try not to scare them. Patients who are scared tend to freeze and fall apart and not cooperate, and that can be dangerous. I have seen it in action at the bedside, and it's awful, and I do my best to avoid that as much as I can while still giving the patient the information they need.

[quazar]

I guess I am guilty of lying to patients if you count lying by omission. In that I don't tell them, "your baby is having xyz decel, which means xyz, which means we need to do xyz intervention." I actually did do that when I was a newer L&D nurse way back in the day, but learned very quickly to not do it because yes, it freaked patients out, to be honest.

People have very selective memories in stressful situations, and filter out a lot of what they are hearing when under extreme stress. Labor and birth, for most people, is VERY stressful, and their memories of it are really skewed. If something they perceive as "bad" happens, that sticks in their mind and they grab onto that and focus on it, even years later. The same with something they perceive as exceptionally "good" happening. It stays with them. For this reason, I try to really minimize any sort of stress inducing communications with my patients at the bedside. Especially with a first time mom. My poker face is well honed now, as is my "calm voice," and those things have served me well when the poo is hitting the fan and I am screaming in my head but trying to not freak out the patient.

So I guess what I'm saying is, yeah, I kind of lie by omission in that I don't really get into the nitty gritty details of the fhr tracing unless I need to do a major intervention like knee chest, trendelenburg, hold up a cord prolapse, or run for a crash c-section. If the tracing is worsening and I can read the writing on the walls, I will calmly let the patient know bit by bit that there are some concerns, and explain as gently as possible what it happening and try not to scare them. Patients who are scared tend to freeze and fall apart and not cooperate, and that can be dangerous. I have seen it in action at the bedside, and it's awful, and I do my best to avoid that as much as I can while still giving the patient the information they need.

[brownbook]

You're not lying you're leaving out the "it could be's".

The baby could be in distress, or your uterus could be compressing the vena cava, lie on your side. The baby could be in distress or you're dehydrated, I'll open your IV.

You don't need to tell patients every "could be".

[ashleyisawesome, BSN, RN]

I don't think I have ever lied about why I am doing an intervention, but I do try to make it sound like it's not a big deal because I don't want them panicking.

If I see a big decel or some recurrent lates/variables, I say "Okay, baby is not happy with you laying on this side, I am going to turn you on your other side and see if he likes it better over there." or "Baby is being a little naughty, we are going to give you a bit of oxygen and see if that helps him behave." If the strip looks flat I might say "baby is looking kind of sleepy so I am going to give you some extra fluids and move you around to wake him up a bit." If I decide to turn the pit off, I say "The pitocin is tiring baby out, so we are going to give him a little break and see if he perks up." If she is having a bunch variables and we decide to do an amnioinfusion I say "Baby is mad that we drained his swimming pool, so we are going to put some more fluid around him so he gets back some of his cushion that he lost."

I just try to remain calm and tell them these things happen in labor and we have ways of fixing them. If I don't seem worried, they feel better about the situation. If they ask for more information, I explain it in more detail depending on their level of understanding.

[ragingmomster, BSN, MSN, RN]

Time and experience have helped me explain to my patients what I'm seeing and what I'm doing without scaring the bejezus out of my patients. Explaining while making frequent eye contact and always speaking slowly have really been my best tools.