Stepping across the line: Information sharing, truth-telling and the role of the personal carer in the Australian Nursing Home

The author draws on an Australian study using multiple qualitative methods to investigate truth telling in aged care. Thematic analysis of data from five nursing homes involving 23 personal care assistants revealed participants’ role understanding as influencing their perceptions about truth telling in practice. Five themes emerged: role as the happy comfort carer, division of labor, division of disclosure, role tension and frustration, and managing the division of disclosure. Role emphasis on comfort and happiness and a dominant perception that telling the truth can cause harm mean that disclosure will be withheld, edited, or partial. Participants’ role understanding divides labor and disclosure responsibility between the personal carer and registered nurse. Personal carers’ strategies for managing the division of disclosure include game playing, obfuscation, lying (denial), and the use of nonverbals. These perceptions about personal carer role, information sharing, and truth telling are paramount for understanding and improving nursing home eldercare

The experience of lying in dementia care: A qualitative study

This analysis examines the practice of care providers in residential aged care lying to residents with dementia. Qualitative data were collected through multiple methods. Data here represents perceptions from registered and enrolled nurses, personal care assistants, and allied health professionals from five residential aged care facilities located in Queensland, Australia. Care providers in residential aged care facilities (RACFs) lie to residents with dementia. Lying is conceptualized as therapeutic whereby the care provider's intent is to eliminate harm and also control behaviour. Care providers of residents with dementia in RACFs need guidance around lying. An ethical framework cognisant of an ethical theory of good and ethical theory of right supplemented by a theory of virtue is proposed. A complimentary four stage communication strategy that promotes truth telling as a first option while also recommending the lie as a suitable strategy is also promoted

On paternalism, autonomy and best interests: Telling the (competent) aged-care resident what they want to know

This paper has been derived from a review of literature from a recent qualitative study that explored the meaning of truthtelling within the care provider-aged resident dyad in high-level (nursing home) care of elderly people. In the literature reviewed here, paternalism (as benevolent decision-making in another's best interests) is critically analysed. Autonomy is then described and its function in promoting health is underscored. Furthermore, this paper specifically challenges nurses to consider their capacity to really know another's best interests-particularly in the nursing home. Finally, a very simple recommendation is proposed for determining and managing the (competent) aged-care resident's informational disclosure preferences: ask them

The care encounter: Pondering caring, honest communication and control

The proposition presented in this paper is that caring, underpinned by beneficence and non-maleficence, assumes that nurses will make determinations about another's best interests and act accordingly. With some emphasis on high-level (nursing home) aged care, it is the author's contention that nurses give priority to communication that controls the care encounter rather than acting in another's best interests. This view is supported in the literature, which suggests that nurses perceive honesty and information-sharing as less important in caring than do patients, and nurses' perception that telling another the truth is harmful and, therefore, contravenes the duties of beneficence and non-maleficence