Essay: 'As a nurse it is acceptable to bend or manipulate the truth'

What is bending or manipulating the truth. Within the nurse to patient relationship truth telling is an important factor as nurses make decisions on a daily basis with regards to what they should tell their patients. This should not be confused by the difference between the truth and the perception of telling the truth where the objective is crucial (Tuckett, 2006).
Within the ICN code of ethics for nurses (2006) it is necessary to ensure a patient is given adequate information to enable them to agree on their required care and treatment. The nurse must consider confidentiality with patients’ information and deliberate when to share, which the nurse is accountable for. The nurse must demonstrate that they are open and honest to gain the trust from individuals and at all times advocate the status of the nursing profession. Within your role as a nurse you are required to act within the laws of the profession and ensure you can validate your choice of actions and omissions (Hasson, 2007).
According to Shaw (2008), for some people the truth is unconditional, but another way of exploring the truth would be to contemplate that there may be several approaches which could be considered.
During palliative care, nurses must identify that there is a component of belief that their idea of truth may differ from that of their patients. When delivering details of the patient’s condition it can frequently be provided by a nurse in a professional manner, which the patient may find difficult to understand (Shaw, 2008).
When a nurse is disclosing information to their patient it is presumed that they would not want to hear bad news as it could result in causing them to become distressed. Due to this, deception may be used to safeguard lives and protect the patient or their family’s feelings (Shaw, 2008).
According to Tuckett (2004) a qualitative study of nurses’ perceptions of lying and deception in clinical practice revealed a lie (as a misleading statement) is defined or described by reference to the context and most importantly the nature of the relationship that comprise the interchange.
There are four different types of truth, direct, factual, personal and interpretive. Direct truth is saying something which leads to a straight answer, for example answering ‘yes’ to the question being asked. Factual truth is making a statement which is objective reality, for example this provides accurate information to the patient which will allow them to carry out a task for example, ‘your glasses are on the table’ which means they would be able to go and get them. Personal truth may be demonstrated by the connection between the patient, relatives and nursing staff whereby personal information is disclosed, for example a relative may disclose personal details about themselves. The final truth type is interpretive, which means the truth is translated by the person responding by looking for reasons behind the question and answers what they presume is being asked. For example this type of response may result from the nurse withholding some of truth when trying to protect the patient and leave them with some hope (Gillotti, 2003).
The concept of truth telling could be described as providing details to a patient on their condition, but omitting the parts which is felt may upset them, therefore making it easier for the patient to accept what they are being told without telling a lie, but providing enough information that does not hurt or upset them. It was considered by Tuckett (2006) that it was reasonable practice to telling a modified version of the truth. An example of reasonable practice would be:
The nurse would not be so direct as to say, look your mum is dying, they would try and soften the impact by saying something like your mum’s health is deteriorating and she is becoming very weak which provides enough information to enable them to understand that their mum’s condition will not improve and will not result in them being totally shocked when death occurs (HSR, 2006).
The information that is provided would be dependent on the condition of the patient and how the nurse felt the patient or their relatives would absorb all of the detail. The nurse would make a full assessment in order to determine the psychological status of their patient and relatives as to how much information to disclose ensuring that the nurse can maintain a calm environment and protecting them from unnecessary upset (Shaw, 2007).
Within a nurse’s role truth telling is related to giving information and interacting with the patient’s care and having the right balance between providing enough detail to enable an independent choice, but without causing avoidable distress by the truth. The nurse is commonly in favour of advising the full truth of a condition, but patients or relatives can request not to be told or be unable to fully comprehend the effects (Nursing Ethics, 2004).
A nurse may also find it difficult to deal with truth telling versus deception, whereby the patient’s family do not wish the patient to be advised of their full medical condition. This poses a dilemma to the nurse as the family may advise that the truth could be harmful to their patient, how does the nurse know if this is the case, therefore the value of truthfulness requires to be measured. Through omitting the full truth this may ease any harm and alleviate the need for bad news (Punjani, 2013).
The Nursing and Midwifery Council (NMC) Code of Professional Conduct (2008) states that: ‘You must uphold people’s rights to be fully involved in decisions about their care. You must share with people, in a way they can understand, the information they want or need to know about their health.’ Previous guidelines from the UKCC in 1996 stated that, ‘if patients and clients do not want to know the truth, it should not be forced upon them.’
Ethical practice must be based on truth telling and is found in the actuality of real life events rather than a solitary framework. A qualitative study of nurses’ opinions of lying and dishonesty in practice areas discloses that a lie, as a false account, is explained by reference to the situation and essentially the substitution within relationships (Tuckett, 2006).
From studies that have been carried out it demonstrates that nurses use deception by omission, to enable a softened approach and to disguise the truth. Consistent avoidance of the truth was found to be used and even although very few nurses lie to their patients, they do provide misinformation and intentionally mislead their patients. A nurse justifies what they do as they feel it is to benefit their patients and sometimes it can be a direction from the doctor. A survey that was carried out in Britain with carers of cancer patients’ showed that even although nurses plea their honesty, they can be expected to avoid direct questions and are required to refer them to a doctor or even lie if the patient wishes an answer to a direct question (Tuckett, 2004).
The nurses’ responsibility when working with a patient on palliative care is to gain how their views of the truth have developed an articulated when looking into how an individual experiences and constructs the truth. It would only be then that the nurse would have gained the knowledge to enable them to be truthful to the patient in an expressive and caring way (Bandman, 2002).
Telling the truth is one of the key points within ethics of the current healthcare system so why is there a reluctance to tell people their full diagnosis in a dementia patient. To enable the nurse to tell the truth to a dementia patient they would require to find out if the patient wishes to know everything about dementia or if they would prefer to just be advised the information which would relate to their condition at that specific time and then going through the stages as their illness progresses (Journal of Palliative and Nursing, 2008).
During the care of seriously ill patients and end of life care, nurses try to preserve hope by balancing truth telling which requires to be a shared understanding within the patient/nurse relationship. Providing honest information to patients and their families is a straightforward moral rule within truth telling. For a nurse not to provide the truth to their patient or family could put their relationships at risk and endangering the patient’s independence. By not disclosing the full truth, this may result in a different meaning to the patient and family. According to Pergert (2012), truth telling is currently an issue within health care due to different cultures and particularly in the care of patients with unfortunate diagnosis of survival. The beliefs of some people with regards to concealing the truth may be seen as commendable, but it is important for the nurse to ensure whether or not the patient would want to know the whole truth or not, the patient should make the final decision with regards to what they want to know.
We see telling the truth as a difficult question that requires consideration on ‘why’, ‘what’ and ‘how’. The ‘why’ is related to the aim of telling the truth, whether based on compassion towards the patient or not. The ‘what’ refers to the element of the truth and the ‘how’ is the way the truth is delivered to the patient (Pergert, 2012).
The ethical and practiced responsibility of nurses to tell the truth within young people and children is greater than the legal policy of doctrine of therapeutic privilege may be more freely mentioned to defend concealment of information (Hendrick, 2011).
When a child is unwell or has a serious condition the nurse should make a decision on what to tell the child with the best interest of the child in mind rather than providing detail based on the child’s age or how the nurse feels they may comprehend (Pergert, 2012).
When a child or young person is dying from a life threatening condition they are usually aware of their imminent death. It will be dependent on the child as to how much of this information they understand and have discussed with the family and healthcare staff. (REFERENCE)))))
According to Jalmsell et al (2014) honest and truthful communication has been recognised as a significant factor in offering good palliative care. However, there is no easy as to how the family should speak with the dying child about death.
An appropriate decision is one which would be within the patient’s best interest and at the same time maintains the honesty of everyone involved. A number of nursing issues are not problems relating to honest, but are basically queries of what is good nursing practice. A significant place to start in ethical judgement is to decide if there is a moral issue exists using a format which may consist of:- moral values or structure which could then be used to give some explanation to enable any action to be taken, the decision is channelled by the means of evaluating the causes, the decision must be chosen in a deliberate manner and choices which may be difficult arise amongst actions that struggle with the wishes of an individual or with others. The decision may be influenced by an individual’s emotions and also by a specific framework of the conditions at that time (O’Sullivan, 2009).
We have reviewed various conditions which can influence the decision of truth-telling. When a nurse is making the decision to tell the truth or to withhold parts of the truth they should always ensure that they are choosing the best option for their patient and family rather than being driven by what is important for the healthcare staff within a tricky or awkward position. Ethnic rules effect