Therapeutic Lying, Ethical? Or not?

[vregino36]

Hello everyone I am very new to this site a little about myself I am 22 and starting nursing school in august. I am a male with a strong interest in learning. Like I normally do when I become interested in something I do bundles of research before I bring it up for discussion. I'd like to get professional feed back on therapeutic Lying on dementia patients. Of course yiu all know dealing with a patient that has dementia can be extra brutal let's say for instance Mrs. Doe goes on a random fit asking where her husband is and starts screaming and crying uncontrollably till you till her. You have two decisions. Decision A tell Mrs. Doe her husband is dead and has been for 15 years and try to re synchronize the patient. (Truth). Or decision B tell mrs. Doe her husband is on his way back from the store with her favorite flavor of jello all while bringing her some jello. I know as health care providers we are there to make living and dying easier so it sounds to me that the Therapeutic Lying is the best choice. What do you all think?...

[klone, MSN, RN]

In the situation you describe, with a dementia patient who cannot be re-oriented, I agree with you.

[pinkiepieRN]

I don't consider it "therapeutic lying", but it is something that I do on a regular basis (probably why I don't consider it a lie). I call it "jumping on the boat". If it can't be verified (like in the instance of a dead husband, and the patient obviously still thinks he's alive or is on his way), I think in the best interest of the patient's mental state. What's going to calm them down - me arguing and flailing at "reality orientation" or going along with what they're saying? What it comes down to is suspending your disbelief/real world mentality and meet them where they are, which is a world of disorganization and confusion. We're not going to fix it, so we'll work with what we have.

[amoLucia]

There have been previous posts here on An re the same subject. I like to call it 'therapeutic fibbing'. Most posters felt OK with the intention of preventing psychic distress to the resident by 'the fibbing'. I would just like to see it care-planned in our LTC careplans as an approach.

[MunoRN, RN]

I think "avoiding unnecessary psychological torture and abuse" is probably a better way of describing it than "lying".

[Ruas61, BSN, RN]

How about accepting their reality? Of course, they need to be safe and have dignity.

[toomuchbaloney]

How about accepting their reality? Of course, they need to be safe and have dignity.

I like this.

IMHO, we are not lying to these patients.

We are engaging in therapeutic communication using language which is familiar to the patient, reassuring them in the context of their "reality" and orientation.

[AmyRN303, BSN, RN]

I don't consider it "therapeutic lying", but it is something that I do on a regular basis (probably why I don't consider it a lie). I call it "jumping on the boat". If it can't be verified (like in the instance of a dead husband, and the patient obviously still thinks he's alive or is on his way), I think in the best interest of the patient's mental state. What's going to calm them down - me arguing and flailing at "reality orientation" or going along with what they're saying? What it comes down to is suspending your disbelief/real world mentality and meet them where they are, which is a world of disorganization and confusion. We're not going to fix it, so we'll work with what we have.

I really like your phrase "jumping on the boat". Great contribution. I worked for two years with residents in some phase of dementia, and that sums it up perfectly.

[bellcollector]

My mother is now 71. She stopped communicating much, lost touch with reality and because she could no longer care for herself has been in a nursing home since she was 58. Like I said this very vocal and opinionated women stopped communicating much but could still be drawn out somewhat. That is until someone got the bright (not) idea to "reorient her to reality". They told her where she was, how long she had been there and how old she was. That was over a year ago and no one has been able to get her to speak a word since. Personally I think it is cruel and abusive. Meet them where they are not where you think they should be. JMHO

[jadelpn, LPN, EMT-B]

With patients who are that demented, in 5 minutes it will be another reality.

So I agree OP, theraputic "fibbing" is something that will calm a patient with dementia.

It must be horrible to not have a reality. To be in a constant state of not knowing where you are or what is happening, or who the heck all these people are.

My grandmother thought her nursing home was her home. And that she had hit the lotto and here we are in a nice home with the whole family around her. The day someone corrected her she cried and cried, but a half hour later all was forgotten and we were back to "what can we do about the color in the living room" conversations. But just those few moments of pain and tears are heartbreaking.

So unless it affects care or is a safety issue, I will agree with any kind of reality that the patient is needing--makes it not so scary for them.

[ArtClassRN, ADN, RN]

You don't do either. Reminisce with the patient "Where did you meet your huband?" "How many children do you have?"

You can be therapeutic without lying.

[Nola009]

You don't "lie", you go with the flow. For instance, I had a patient w/ dementia keep asking me where her car was. I said: "I don't know. What does it look like?" (The lady hasn't had a car in oh, 20 yrs.) So, she described what she was talking about and I said "No, I haven't, but I will keep an eye out for it." It greatly agitates them to constantly be confronted, point blank, with what they don't perceive to be their reality.