Pt's mom asks to you lie to the pt---What to do?

nurse2033, MSN, RN · Nov 17, 2010

I would not have lied to the patient. You want the patient to trust the health care team. If Mom wants to lie that is her business, her consequences, and her relationship. There are a plethora of books on nursing ethics at amazon.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Nov 17, 2010

I'd never lie to a patient. Your observation of the mom being anxious is important. If she were calm about the surgery, inspiring confidence in her from the child, there'd be no need to lie in the first place. I'm ER oriented so I'm hoping a psych nurse can jump in here with more definitive answer for you.

Davey Do · Nov 17, 2010

Oooooh, dthfytr, I was waiting until an ER Nurse jumped in so the best answer would be given.

I agree with both your and nurse2033's answers. Trust is a very big factor in a therapeutic relationship. And this is no "little white lie". No one gets hurt with a little white lie. A relationship has the potential to suffer big time if the trust factor is broken.

Professionally speaking, I would convey a sense of understanding to the mother and do whatever I could to help quell her fears. However, I let all know that I have a duty to act within the guidelines of my education, knowledge, and experience. Which means I have both ethical and moral standards to adhere to.

Now. I pride myself at my ability to utilize the "Poetic License" technique and manipulate my media, in a therapeutic manner, to achieve a desired outcome. At times I even been accused of "having a gift for fiction".

Truth, like an opinion, is merely a perspective.

I could go on and on. But, I won't.

Hope you get my gist.

Dave

Cuddleswithpuddles · Nov 17, 2010

Thanks for the replies :)

What would you guys do if the mom said not to lie but just not tell the kid what's going on? She is the legal guardian after all.

What would you say if the kid asked you point blank?

Ruh roh. :-S

Davey Do · Nov 17, 2010

"What if the patient asks you pint blank" is a difficult question to answer based on the available information:

I am a home health LVN. I accompanied one of my pediatric patients' to the ER. He asked me if he was undergoing surgery that day. The mother took me aside and told me to lie so that he would not be anxious. She was very anxious herself. In the end, I felt the best thing to do was to keep quiet and let the ER RNs take the lead in informing the family of any plans for surgery.

I had to agree with your tact of allowing the Hospital Staff to deal with the situation. However, this is merely a discussion to me. You, JDBinCA, have to deal with the reality of the situation.

Based on that premise, I will continue the discussion.

The patient asks, "Am I going to have surgery?"

Me: "I don't know." (Provided that I don't know for sure.) "There is a possibility for that to happen. But it's not up to me. It's up to your Doctor. S/He and your Mom will decide what's the best thing for you to help you get better. How do you feel about my answer?"

Patient: "I'm scared."

"It's alright to be afraid. In other words, it's very normal. Can you tell me what you're afraid of? "

So, basically, I'd get the Patient to talk about his fears and console him with empathy and information.

As I said before, exactness is difficult without having full knowledge of all the information and variables involved with this scenerio.

However, I've done the best I could by giving you a gist.

Dave

nurse2033, MSN, RN · Nov 17, 2010

I would tell the Mom I won't lie to your child. I would tell her that as a nurse I have a ethical directive not to lie. She might actually appreciate that you have the fortitude to do so. Point blank leaves you no choice. As I said I would not lie to the patient. Telling people what they don't want to hear is part of our job. Socially your impulse is to comfort and say "don't worry, it will be OK". But your job is to tell the honest truth. If you show compassion while delivering bad news such as "I'm sorry to have to tell you this but..." this allows people to prepare themselves and hear you. This might be the first time you have had this issue but it won't be the last. You can't know all the dynamics of families, which can go back to the Nixon administration, or earlier. We don't lie to patients period. We might choose to be vague but lying is unethical. Since we can't foretell the future, I usually say something like "in my experience" or "from where I sit, this is what I see"... This allows to tell what you think will happen, unless we are passing along the decisions of others, say a surgeon. If the patient is going to surgery, tell them. If you think they might have surgery tell them that. Just be open and honest and you will never regret your actions. Lying or deceiving could have unforeseen consequences that you might regret later. It's true a parent is a legal guardian, but they don't have control over your actions, just those of the child. In my mind the relationship of nurse to child is separate and different than the relationship of parent to child. That child is an individual that deserves to be treated as any patient of ours. We assume that the parent is always thinking of the best interest of the child, but any recent news page shows that not always to be the case. This is unfortunate but true. Sorry to blather on but this is a core issue to nursing and near and dear to my heart. Thanks for such a provocative question.

allnurses Guide · Nov 17, 2010

I work in home health, too. I don't think I could answer your question based on the information you provided, but ignoring the parent's desire that you not tell the child at that particular moment would be done only if there were no other options and a compelling need.

What I would do depends on the the child's age, the diagnosis and duration of illness, and my knowledge of the family dynamics. If the child is eligible for skilled nursing care at home, and he knows that surgery is a possibility, he's probably been chronically ill for quite a while. That would mean that his parents have been his primary caregivers over that time, with the assistance of nurses/caregivers and have established a pattern of communication with their child with respect to his limitations. If he asks you if he's going to have surgery he's probably had surgery before. How did the parents go about informing him on those other occasions?

They may not have meant "lie" but delay. They are the experts on their child, and may very well have an established playbook for delivering bad news to their child.

One of the hardest things parents of children with special needs have to cope with is the feeling that their role as a parent is shared by myriad other people. It makes bonding issues precarious at times, not what you want to have happen here as the constant wear and tear of caring for their child can bring risks to his safety in time.

If the parent has an established pattern of withholding information from the child, they will need more help than you as a part-time nurse can give and maybe they need a social worker or family counselor referral.

BabyLady, BSN, RN · Nov 17, 2010

Hello everyone,
I am doing a paper on a dilemma I encountered at work.
I am a home health LVN. I accompanied one of my pediatric patients' to the ER. He asked me if he was undergoing surgery that day. The mother took me aside and told me to lie so that he would not be anxious. She was very anxious herself. In the end, I felt the best thing to do was to keep quiet and let the ER RNs take the lead in informing the family of any plans for surgery.
Do you know of any books, articles or professional guidelines that specifically address this issue i.e. what to do when the legal guardian specifically asks the nurses to withhold information/lie to the minor? I have gathered a few, but putting in the right search terms is quite tricky.
Have you encountered this situation yourself?
What would you have done?
Thanks everybody!

I would inform the physician that the patient has not been informed and let them handle it.

If you make a decision like that yourself, that could land you in hot water.

The age of the patient and mental capacity, is also important.

WoosahRN, MSN, RN · Nov 17, 2010

I work in Peds and have had this situation come up before. I usually tell the parents that while I won't go out of my way to tell the patient information it is important for the child to know what is going on and that I cannot directly lie. I emphasize trust and coping and state that usually the child has already figured out that something is wrong, especially because of this avoidant behavior. We have the ability to get social work and child life involved as well. I've had parents ask us not to tell the child that they have cancer or some other new diagnosis. Usually it is the parent's anxiety reflecting on the situation, like if they don't tell the kid they won't notice they are in the hospital, getting medications, don't feel good. I don't get it but I can see it being a coping (or non coping) thing. I've never lied to a patient but I also try to respect a family's wishes until I can talk to them and find out why they don't want to tell the child what is going on.

I did have a situation where a kid came in with a major brain bleed. I work in PICU so he was intubated and critical for a while. During this time his dad, who had been sick with cancer, also died. The mom asked us to not discuss this in front of the patient. He was still not alert but she didn't want him to find out yet and wanted to be the one to tell him. And she wanted him to be able to focus on getting better. That I can respect as that is not my business to tell and i was not put in a position where I had to lie.

Personally, when my grandfather was dying in the hospital (before I was a nurse) I remember my family being all hush hush and not telling him what was going on. I found it extremely disrespectful and typical of not being very communicative. They chose an action plan without talking to him. And how could he not know? The mood was somber and it was obvious with how much we were at the hospital and acting. I think it would scare someone more to have that behavior going on around you without anyone verbalizing what was happening.

WoosahRN, MSN, RN · Nov 17, 2010

I guess I didn't really answer the question.....

As far as what you should do in your specific circumstance I would say that there you aren't sure but if it is something that needs to make him feel better, surgery could be a chance. I would pre-empt this with making sure that mom knows you are not willing to lie (and explain why) but that he needs to know that it might be a chance. Ultimately you don't know the end result of that care since his care was transferred over to the hospital. Even with my own patients, the surgeons or intensivists are the ones that need to discuss this kind of care plan. I should not be the one to break the news to them that they are having surgery as I will not be able to answer all their questions and it can and will increase their anxiety and make the situation worse.

OttawaRPN · Nov 17, 2010

I don't lie to my patients, there are age appropriate ways to convey bad news w/o traumatizing the patient. The parent appears to be thinking of their own needs/fears first and may even be in denial themselves. I don't play into that, I'm the patient's advocate, not the parents. Very often the parent just needs some extra encouragement and support to see the benefit of being honest and, as nurses, it is definitely within our role to provide that teaching. However, if all else fails, for goodness sake's get the docs, SW etc. involved, a patient cannot consent if they don't have all the facts and a dilemma such as this should be constructively solved within a team approach not dumped on the poor nurse to fix just because s/he is on the front line.