Wholetruth, Untruths and Lies: An ethnographic study of communicative interaction between professional caregivers and people with dementia

Murray, Jane Elizabeth (2021) Wholetruth, Untruths and Lies: An ethnographic study of communicative interaction between professional caregivers and people with dementia. Doctoral thesis, Northumbria University.

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Abstract

The current literature highlights that professional healthcare staff admit to regularly telling lies in practice, to people with dementia. This, despite the Nursing and Midwifery Council and the General Medical Council being explicit in their codes of conduct that nurses and doctors must not tell lies to patients. Both codes also highlight the duty of beneficence and non maleficence, and it is known, that sometimes, telling the truth to people with dementia can cause great distress.

The purpose of this study was to use ethnography to undertake a critical analysis of the concept of lying in clinical practice in the context of people with dementia. The aims of the study were as follows:

• To develop a taxonomy of lies
• To use the taxonomy to develop a model which could be used in practice, to explore the impact of lie telling

Current literature has used either phenomenology or grounded theory to ask staff their perceptions of what they say when they tell lies. Uniquely, the methodology used for this study was ethnography, with the researcher acting as a complete participant observer, observing lies told in practice to people with dementia by staff (nurses, doctors, allied health professionals and healthcare assistants). By using ethnography, this study has recorded previously unidentified phenomenon and brought new knowledge and insight to the topic area. Data was collected from two wards for people with moderate to severe dementia over a period of 45 shifts, equating to approximately 338 hours. The data was analysed using thematic content analysis.

Six categories of lies emerged from the data which formed the taxonomy: familiarity, banter, props, going along with, avoidance and delaying and blatant. The taxonomy was then used to develop the Lie ARM (Affective Reflection Model) to enable healthcare professionals to reflect on the practice of telling lies and consider the effectiveness of them. Findings from the study can be used to challenge current policies around lie telling; specifically, that whilst truth should always be the starting point, telling lies to patients with dementia can be a kind and effective intervention to support their personhood and reduce distress.

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