Why lying to demetia patients can be ethical
January 21, 2009 at 8:11 am 5 comments
Three weeks into the quarter and Ive come to really believe that dementia is an awful disease, more horrible than any disease I have ever heard of. Its even worse when the patient wants for a family member or significant other that has passed away. As RN students we have ethics shoved down our throats, including telling the truth at all costs. “A truthful Nurse is one who succeeds”. I believe in telling the truth, really I do. But I do not think that telling a patient with dementia the brutal truth is helping us to “do no harm”. Here is the scene I witnessed last week.
Picture a pleasant elderly patient who asks you every hour or so about their spouse. Here is how the seasoned nurse handles it:
RN:”Hi Mrs.______, how are you this morning?”
Mrs.____: “Where is my husband? Where is _________?”
RN: “Im not sure ma’am, but let me look at that seeping decubitus ulcer on your hiney”
Mrs.____: “Im going to lunch with my husband today. He said he would come.”
RN: “Oh thats nice, now let me finish your wound check.”
Mrs.____: “When will he be here?:
RN: “I dont know. But lets get you dressed.”
An hour later, enter freshly born Nursing student:
RN student: “Hi Mrs.______, Im ______from the nursing school. Im going to perform a wound check on you today.”
Mrs._____: “Where is my husband?”
RN student: “Is he supposed to be here? Let me go look for him”
Rn student goes to chart and sees that the spouse is deceased
RN student: “Im sorry Mrs._____, but your husband passed away many years ago. He wont be coming here.”
Mrs._____: Crying inconsolably until she finally falls asleep without wound check.
The nursing student was so torn up. I heard her crying in the bathroom, and felt so bad that she got stuck in that ethical dilema.
But what would you have done?
Entry filed under: Clinicals, questions?. Tags: .
1.
Drofen | January 21, 2009 at 8:47 am
I think it’s terribly easy to preach all things black and white in the academic setting. Life is not black and white, but many shades of gray.
I think the trick is to stay mostly on the lighter side of the spectrum…
2.
Lorie | January 21, 2009 at 12:16 pm
Having been in this situation many times in my 12 years of nursing I would have done the same thing that the nurse did. I have done the same thing the student nurse did and I felt horrible after too. You live and learn and each situation is different. I have oriented some dementia patients in that manner and they have accepted it fine and just said “oh thank you” others will cry. I have found the best thing to do when working with a patient like that is to ask another nurse or aide who is familiar with them what the deal is.. is the spouse dead? What is the best way to answer this person? If there is no one to ask then I give open ended answers like “oh I didn’t realize he was coming, let me check this on you real quick and I will see what the deal is with your husband coming” or “Well I am not sure if he is coming or not but first let’s do this”. Good luck and I hope your fellow student does not take it personal.. it could happen to everyone and the patient more than likely does not even remember today! Sorry so long!!
3.
Christine | January 21, 2009 at 12:18 pm
Coming from experience it is easier to keep a pleasant dementia patient pleasantly distracted.
Its tough to know that line between our reality and theirs.
4.
alicia | January 21, 2009 at 2:48 pm
oh wow, so tough! poor student.
5.
Heather | January 22, 2009 at 2:34 pm
I can totally appreciate and understand what you’re talking about! I have had quite a few of “lost elders”. At first I tried being truthful, trying to remind them where/who/when they are. But, it seems so much kinder to just put in a “really?” “Huh.” “what is your husband like”. You know what I mean? Change the subject to something they can chatter on about even if it’s not completely accurate. I mean who are we to say, that the only valid conversation is something based in 2009? Hmph.