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

[Cuddleswithpuddles]

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!

[KidzNrz17]

I'm a peds nurse. I think I would ask the child what scares you about surgery and go from there. There are some kids that you do have to wait til the last minute to tell about procedures because they can get so upset. Some kids want to know everything way ahead of time.

Maybe the mom has seen what happens to the kid when he gets a little information.

Because I want to have a decent relationship with parents of my kids I would not turn around and just tell a kid something a parent just asked me not to tell. But I would try to help find out what the child feared and try to answer questions.

[mentalhealthRN]

The fear of the unknown is usually worse then the actual thing. Everything I learned in school in my peds rotation was based on developmental level. So it does depend on the age of the child. There is a seseme street book called grover goes to the hospital. My daughter had it when I had to bring her to the hospital around age 4 to get tubes in and adenoids out. It was helpful. We went to the surgical center ahead of time and the nurses were great with my daughter. They had her go into the OR (not sterile at the time), play with a stethoscope, put on the hair cap thing she would be wearing, touch things and look at things and ask questions. We arrived and they gave us the book in the waiting room. I read it to her and then the nurses brought us back for a "practice run". This made the whole thing so much less scarey and she did great the day of the surgery. Oh and she got a popsicle at the end of the "practice run" too just like she did on the real day. The child will look to those around her for her own reation. If they seem scared she will be too. That is developmental. This is just my opinion as a mom, a psych nurse and I was a teacher prior to being a nurse. It will only be scary to the child if mom makes it that way. A child doesn't know to be scared. Bring in the social worker if need be. And keep the explaination to the child simple and leave out scarey details. Have the child bring a stuffed animal that comforts them and let them have it until they are asleep and give it back in PACU for when they wake. Good luck to you.

[tryingtohaveitall]

As a pediatric nurse, we are not only taking care of the child but we are taking care of the parents/family also. This is what family centered care is all about. We are all a team taking care of the child.

We don't know that the child hasn't had surgery before and isn't going to freak out. While I would not lie to the child, I absolutely wouldn't break the mother's trust by going against her wishes.

Recently my 5 year old had her well child visit. She asked me a couple of times if she was going to get a shot. I tried to distract her and not answer her question as long as I could. Once I told her what was going on and that yes, she was going to get a shot, she totally freaked out on me, just like I thought she would.

It's all well and good to say that if the mother is confident the child won't be upset, but I'm afraid that's not reality. After 21 years of pediatric nursing (and 17+ years of parenting with several surgeries of my own kids under my belt), I can tell you with all confidence that every child reacts differently and yes, some are going to freak out. That's why it's so important to work with the parents. They know their child far better than we do and we need to work together.

[leslie :-D]

and so op, as you can see, there is not a definitive answer.

as a nurse, we have to assess the child's readiness, dynamics of the family unit, while staying true to our core principles.

when i was doing peds hospice, i had parents demand that i NOT tell their child that they were going to die...

which wasn't always complicated, since they had all been sick for awhile and were accustomed to caregivers coming in their home.

but...i have had children ask me if they were dying (with parents eyes leering at me).

there is nothing black and white, about questions such as yours.

we encourage questions and conversations.

one simple question can take you to a whole other aspect of the illness and dying.

the most helpful strategy i have found, is developing a trusting relationship with all.

parents want to know that you have their child's best interest at heart, while respecting the parent's anxieties and fears.

and always, that takes you on a road with many twists and turns.

if you stay true to your goals of doing no harm, everyone should win in the end.

just give time and faith, a chance.

leslie

[caliotter3]

"I don't know" or "I'm not sure" both cover a lot of ground. "You will need to ask your doctor" takes up the slack.

[Grammyx6]

I have always been honest with my patients, including children. Example: when my granddaughter was getting immunizations she looked at me & said, "it's going to hurt." I told her, "yes, it will, but only for a minute or two." She did great because I validated her fear and gave simple facts. Children seek honesty just like adults.

[Jbutler9743]

I don't think you should have lied to the patient, if they are old enough to understand that they are having surgery, they have the right to know. I may have said ..you should talk to your mom about that or talk to your doctor about that. But I would never lie to a patient for any reason. I think that would be unethical.

[klone, MSN, RN]

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.

In an ideal world that would be true. However, some children, especially those with delays or on the autism spectrum, have a much higher level of anxiety than other children, and no amount of calmness or prior talking to the child will quell that. So the options are: tell the child about the procedure the day before and have the child anxious and fearful for an entire day; or tell the child right before the procedure and have the child anxious and fearful for ten minutes.

As a healthcare provider, I would never lie to a child. As a parent of a child on the autism spectrum, I've not lied but I HAVE withheld the truth. To my child I try to remain calm, but to a professional I imagine I would seem somewhat anxious.

[tainted1972, ASN, RN]

I do not work with Peds. However during my Peds rotation i had the opportunity to watch several surgeries. Each Child was brought in to the OR awake. Any child that is aware enough to ask the question "am i going to have surgery" Has every right to be informed of it before hand. I just can not imagine the fear a child would have being wheeled into an OR where it is obvious that something major is about to take place... and not knowing what is about to happen.

[Katie5]

You lie once, you'll lie again.I'll say redirect the mum to someone who can best help her,like you did:)

[indigonurse]

If the parent or legal guardian made a request like that then I would not volunteer information. If the pt. asks questions then I would pass the question onto the parent/legal guardian and let them answer the question how they see fit. I would also inform the MD. I would also do an intervention in the way of teaching the parent/legal guardian about why it is necessary to be honest with the pt. and inform them of the benefits/risks of withholding the information. Under no circumstances would I lie.

[swirlything]

An MA, passing herself off as a nurse, lied to my daughter once when she was about 10. She said that a rocephin injection wasn't going to hurt, but knew full well that it was. My daugher, now 3 years later, still does not trust nurses and outrightly says that "nurses lie to you."

I say, do not lie to the patient.