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Pritchard J. Using therapeutic lies - an ethical challenge for nurses when caring for people with dementia. Nurs Older People 2024:e1468. [PMID: 38444165 DOI: 10.7748/nop.2024.e1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 03/07/2024]
Abstract
People living with dementia can become vulnerable when experiencing symptoms such as memory loss and disorientation, as well as stigma attached to the condition. The care of people with dementia is fraught with ethical dilemmas and challenges regarding how nurses should respond to situations that put patients at risk of distress. For example, if a person with dementia asks to see a deceased relative, a nurse may have to decide whether to tell the truth, or a 'white lie' to avoid distress. This article examines the debates around the use of such 'therapeutic lying' when caring for people with dementia and provides guidance on how nurses could use this technique while protecting the individual's best interests.
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Long S, Irving K, Murphy C. Is therapeutic lying contradictory to person-centred care? Toward understanding the connection. Aging Ment Health 2024; 28:520-530. [PMID: 37139937 DOI: 10.1080/13607863.2023.2202632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
AIM There is a lack of clarity about therapeutic lying in the context of everyday dementia care. This study provides conceptual clarity on how the term is used and considers the concept in relation to person-centred care. METHODS Rodgers' (1989) evolutionary framework of concept analysis was employed. A systematic multiple database search was conducted and supplemented with snowballing techniques. Data were analysed thematically through an iterative process of constant comparison. RESULTS This study highlighted that therapeutic lying is intended to be used in the person's best interests for the purpose of doing good. However, its potential for doing harm is also evident. Its use in the literature has increased with the general trend towards becoming more accepted in the discourse. A continuum emerged depending on the degree to which a lie departs from the truth. Emerging guidelines were also evident as to when a lie could or could not be justified. CONCLUSION The term therapeutic lying, was contrasted with aspects of person-centred care and was found to be problematic. We conclude that there may be more pragmatic ways of constructing language around the care of people with dementia which could be less stigmatising.
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Affiliation(s)
- Shirley Long
- Nursing, Community Health Organisation, Dublin, Ireland
| | - Kate Irving
- School of Nursing, Dublin City University, Dublin, Ireland
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Hartung B, Freeman C, Grosbein H, Santiago AT, Gardner S, Turzanski M. Evaluation of a Workshop on Therapeutic Lying and Dementia Care for Long-Term Care Staff Supporting Persons With Dementia. J Contin Educ Nurs 2021; 52:438-444. [PMID: 34432585 DOI: 10.3928/00220124-20210804-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Therapeutic lying is an intervention used by health care professionals (HCPs) when a person with dementia is disoriented and distressed and when all other interventions have not succeeded in deescalating the symptoms of dementia. METHOD The goal of this study was to evaluate a workshop on therapeutic lying and dementia care for HCPs specializing in the care of persons living with dementia with symptoms of dementia. Seventeen HPCs, including nurses and personal support workers (PSWs), participated in the workshop and evaluation survey. RESULTS The workshop did not affect the attitudes of HCPs toward therapeutic lying and dementia, their sense of competence in providing care to patients with dementia, or their rate of admitting to using therapeutic lying in dementia care settings. All of the PSWs and 50.0% of the nurses admitted to using therapeutic lying as an intervention. Conclusion: Current nursing ethics standards and training practices may cause reluctance among nurses to include therapeutic lying in care plans as a last resort and as a person- and family-centered intervention to deescalate the symptoms of dementia. [J Contin Educ Nurs. 2021;52(9):438-444.].
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Tobis S, Neumann-Podczaska A, Yermukhanova L, Sultanova G, Kurmanalina G, Kimatova K, Dworacka M, Wieczorowska-Tobis K. Pain in People with Advanced Dementia: The Opinions of Kazakh Medical Students. J Pain Res 2020; 13:3307-3314. [PMID: 33324091 PMCID: PMC7732167 DOI: 10.2147/jpr.s276479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The medical students’ attitude toward pain in people with advanced dementia, while constituting an important factor in care, has rarely been assessed to date. The aim of our study was thus to perform such assessment in medical students in Kazakhstan, to enable an improvement of the existing curriculum (like we previously did in Poland). Materials and Methods We analyzed the knowledge about pain using a short anonymous questionnaire, which was completed by 112 students of the Medical University of Aktobe, Kazakhstan. Results On average, students listed symptoms of 1.4 ± 1.2 (out of 6 analyzed) pain areas (median 2.0). The symptoms related to changes in mental status were suggested the most often (57 students: 50.9%). The students who indicated these symptoms also listed a higher number of symptoms from the remaining domains (1,1 ± 1.0 [median 1.0] vs 0.6 ± 0.8 [median 0.0]; p<0.01). Observational methods in the assessment of the severity of pain in people with dementia were indicated by 44 students (39.3%), but only one participant (0.9%) was able to name an observational scale for pain assessment. Correct answers regarding pain treatment rules were presented by 18 students (16.0%), and the answers of the next 47 participants (42.0%) were very general but suggested the same treatment no matter what the cognitive status. Conclusion The study revealed gaps in the knowledge of Kazakh medical students regarding pain in advanced stages of dementia. Demographic changes, combined with the coexistence of pain with dementia, indicate that medical students worldwide must have sufficient knowledge and skills to adequately care for the continually growing number of people with these conditions. It is imperative in countries like Kazakhstan, where the dementia burden was unrecognized until now, but it will blow up in the near future.
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Affiliation(s)
- Slawomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Neumann-Podczaska
- Geriatric Unit, Department and Chair of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Lyudmila Yermukhanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Gulnara Sultanova
- West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Gulnara Kurmanalina
- Department of Internal Medicine, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Kerbez Kimatova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Marzena Dworacka
- Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Wieczorowska-Tobis
- Geriatric Unit, Department and Chair of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Hartung B, Freeman C, Grosbein H, Santiago AT, Gardner S, Akuamoah-Boateng M. Responding to responsive behaviours: A clinical placement workshop for nursing students. Nurse Educ Pract 2020; 45:102759. [PMID: 32294572 DOI: 10.1016/j.nepr.2020.102759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/06/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
As our population ages, it is important for the next generation of nurses to feel prepared to care for people with dementia. Communicating with a person with dementia who is experiencing responsive behaviours can be challenging. Furthermore, new graduate nurses may experience a phenomenon called reality shock when they do not feel prepared for the reality of nursing. Reality shock can lead to nurse turnover and poor retention rates. This study evaluated a workshop for first-year practical nursing students focusing on applying a person-centered communication framework when caring for people with dementia experiencing responsive behaviours. The results suggested that training students during their clinical placements on dementia communication may be effective in helping prepare nurses to care for this patient population.
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Affiliation(s)
- Benjamin Hartung
- Baycrest, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
| | - Calen Freeman
- Baycrest, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Haddas Grosbein
- Baycrest, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
| | | | - Sandra Gardner
- Baycrest, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada
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Casey D, Lynch U, Murphy K, Cooney A, Gannon M, Houghton C, Hunter A, Jordan F, Smyth S, Felzman H, Meskell P. Telling a 'good or white lie': The views of people living with dementia and their carers. DEMENTIA 2019; 19:2582-2600. [PMID: 30803272 DOI: 10.1177/1471301219831525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A common symptom of cognitive decline in people living with dementia, or people with memory problems, the cause of which has not yet been diagnosed, is the person repeatedly asking for loved ones who are deceased or making statements that are incorrect. Carers are then faced with a dilemma, do they avoid and distract or 'correct' the person and tell the 'truth', or tell a lie. This paper explores the concept of lying from the perspective of people living with dementia in the community and their informal/unpaid carers. METHODS A descriptive qualitative study utilising focus groups to collect the data was conducted. Three focus group's with a purposive sample of people with memory problems (n = 14) and three focus group's with informal/unpaid carers (n = 18) were undertaken. Qualitative content analysis was used to analyse the data. RESULTS All participants considered that blatant lying with the intention to deceive and do harm is not acceptable. However, telling a 'good lie' or 'white lie' to alleviate distress was in certain circumstances considered acceptable. The intention behind the 'lie' in their view had to be to do good, and the informal/unpaid carer telling the lie had to really 'know the person' and be cognisant of family preferences. Some informal/unpaid carers acknowledged that it may be acceptable for health care professionals to tell a 'good lie' or 'small lie' in certain circumstances. However, health professionals need to 'know the person' and need to consider informal/family caregivers' wishes. CONCLUSION Lying was only considered acceptable in the context of knowing the person and when done with the intention not to harm or deceive, undertaken with empathy, and only for the purpose of mitigating the person living with dementia's distress.
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Affiliation(s)
- Dympna Casey
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | - Una Lynch
- Sonrisa Solutions Limited, Banbridge, Co. Down, UK
| | - Kathleen Murphy
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | - Adeline Cooney
- Centre for Teaching & Learning, Maynooth University, Maynooth, Ireland
| | - Mary Gannon
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | - Catherine Houghton
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | - Andrew Hunter
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | - Siobhan Smyth
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland
| | | | - Pauline Meskell
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland; Nursing & Midwifery, University of Limerick, Ireland
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Fisher JM, Tullo E, Chan K, Teodorczuk A. Twelve tips for teaching about patients with cognitive impairment. MEDICAL TEACHER 2017; 39:452-457. [PMID: 28440722 DOI: 10.1080/0142159x.2017.1288863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The global population is ageing and consequently cognitive problems are increasingly prevalent. To ensure that the healthcare needs of this complex group are met, healthcare professionals must receive adequate training in this field. There are, however, a variety of reasons why this is not currently being achieved, including, but not limited to: ethical and logistical issues relating to the delivery of educational experiences involving cognitively impaired patients; a failure of curricula to keep pace with the changing demographic; societal and institutional ageism; and the inherent complexity of the conditions. This article highlights challenges associated with the delivery of such training to medical undergraduates and presents strategies to tackle these. Drawing on current evidence where available, the 12 tips below offer educators practical advice on how to maximize the value of medical undergraduates' educational experiences with cognitively impaired patients.
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Affiliation(s)
- James Michael Fisher
- a Department of Geriatric Medicine , Northumbria Healthcare NHS Foundation Trust, North Shields , United Kingdom
| | - Ellen Tullo
- b School of Biomedical Sciences, Newcastle University , United Kingdom
| | - Kwong Chan
- c School of Medicine, Griffith University , Queensland , Australia
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Tullo ES, Young TJ, Lee RP. Medical students' views about person-centred communication in dementia care. DEMENTIA 2016; 17:573-584. [PMID: 27235845 DOI: 10.1177/1471301216651981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adopting principles of person-centred communication has been highlighted as one strategy to improve care of people living with dementia (PLWD) in health and social care settings. However, person-centred communication is interpreted and applied variably in different settings, and healthcare professionals' views about communicating with PLWD are under-explored. This study aimed to investigate medical students' views about the principles and applicability of a model of person centred communication - the Dementia Model of Effective Communication (DeMEC) - to clinical practice. Quantitative and qualitative data was collected using questionnaires ( n = 531), focus groups ( n = 21) and interviews ( n = 10). Students generally endorsed the person-centred approach to communication, but two aspects were highlighted as complex and divisive - the acceptability or otherwise of lying, and of communicating with family in advance of the PLWD. We discuss the nature of these communicative dilemmas, implications for the education and training of medical students, and future directions for research.
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Affiliation(s)
- Ellen StClair Tullo
- Newcastle NIHR Biomedical Research Centre in Ageing and Chronic Disease, Newcastle University Institute for Ageing, Newcastle University, UK
| | - Tony Johnstone Young
- School of Education, Communication and Language Sciences, Newcastle University, UK
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Abstract
OBJECTIVES Whether and how patients should be told their dementia diagnosis, has been an area of much debate. While there is now recognition that early diagnosis is important for dementia care little research has looked at how dementia-related diagnostic information is actually verbally communicated. The limited previous research suggests that the absence of explicit terminology (e.g., use of the term Alzheimer's) is problematic. This paper interrogates this assumption through a conversation analysis of British naturalistic memory clinic interaction. METHOD This paper is based on video-recordings of communication within a UK memory clinic. Appointments with 29 patients and accompanying persons were recorded, and the corpus was repeatedly listened to, in conjunction with the transcripts in order to identify the segments of talk where there was an action hearable as diagnostic delivery, that is where the clinician is evaluating the patient's condition. RESULTS Using a conversation analytic approach this analysis suggests that diagnostic communication, which is sensitive and responsive to the patient and their carers, is not predicated on the presence or absence of particular lexical choices. There is inherent complexity regarding dementia diagnosis, especially in the 'early stages', which is produced through and reflected in diagnostic talk in clinical encounters. CONCLUSION In the context of continuity of dementia care, diagnostic information is communicated in a way that conforms to intersubjective norms of minimizing catastrophic reactions in medical communication, and is sensitive to problems associated with 'insight' in terms of delivery and receipt or non-receipt of diagnosis.
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Affiliation(s)
- Elizabeth Peel
- Institute of Health & Society, Psychology Department, University of Worcester, Worcester, UK,
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