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'It seems vital that nurses always remain honest with their patients'


Student nurse, Elena Ivany, debates the pros and cons of clear communication

In modern healthcare, patients have an intrinsic right to receive as much information about their care and condition as they require.

Individuals can request to read their notes, participate in the clinical decision-making process and medical professionals must ensure that all patients are aware of the implications of any treatments or procedures being administered.

Yet, despite this drive to ensure that all patients are kept well informed, situations do occur when clients are kept in the dark about decisions that affect their care and their health.

Clearly, forcing a patient to deal with a barrage of medical information is neither necessary nor appropriate. While some clients thrive on having access to facts and figures, others prefer to rely on their nurses’ and doctors’ knowledge and experience.

Given the nurse’s role as a patient advocate, it falls to nurses to know each client’s individual requirements so as to facilitate the provision of relevant and personalised information that will educate, support and reassure the patient.

Equally, there are occasions when a patient may not be able to understand or process key information, in which case much of the decision making will need to be made by the inter-professional team in conjunction with the client’s next of kin. But what of situations where the patient does have the capacity to understand and does want to access information and advice about treatment but has received a negative prognosis?

In such situations, is honesty still the best policy?

I know of a patient who is receiving palliative care for terminal cancer. The prognosis is not good and the medical team are keen to transfer them to a hospice, a decision that the patient doesn’t agree with. Part of the problem, as I have come to realise, is the fact that the patient is lacking key pieces of information about their own medical condition and the type of care they are receiving. As a result, they are being asked to make important decisions based on a rather murky mix of beliefs and medical half-truths.

If honesty is in fact a key element of nursing care, then would it not be the nurse’s duty to encourage an open dialogue between the patient, her family and her healthcare team?

Furthermore, would allowing the patient to access all the information required to make important decisions not be considered an aspect of the nurse’s role as a patient advocate? Although the idea of truthfulness is often simpler than the practice of speaking the truth, I feel that it is right that nurses should have open discussions with patients, whatever their’ condition.

While doctors may be the ones to diagnose, nurses are the ones to care, guide and support and, for this reason, it seems vital that nurses always remain honest with their patients. 


Readers' comments (2)

  • Some good points. However,the idea that "...... I feel that it is right that nurses should have open discussions with patients, whatever their’ condition....", may not always be the best approach. Not all patients wish to have 'open discussions', and this has to be respected.

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  • The ethico-legal basis for the provision of treatment, in not consent: the basis is informed consent. The emphasis is that treatment without consent is an assault, and that the consent must be adequately informed – clinicians are, therefore, required to inform their patients, of the clinical consequences of accepting or refusing any offered treatment. The Mental Capacity Act even seeks to extend this principle of informed consent into periods of mental incapacity: in fact, if it is anticipated that a patient might become mentally incapable, the MCA assumes that the patient’s wishes will be sought about possible future decisions, and also tells you that if the patient will not make a choice, the consequences of not making a choice must be described to the patient (section 3 (4) (b)).
    Whether being told ‘will upset a patient’, is a question the answer to which should normally not preclude the provision of the information. Being told that ‘we think you be dead within a year’ could well upset a patient, but what if you do not tell him – wait until he has perhaps a couple of months left, when he will have realised ? You have deprived him of the best part of a year, while he was presumably healthier, during which time he could sort out his life – arrange an up-to-date Will, say his goodbyes, perhaps visit relatives who had emigrated, etc.
    The ethics is not ‘we decide what is in the patient’s best interests’ but ‘we inform him, and he makes his own decisions’. And, since the GMC published some very clear guidance about this last year, any doctor who adopts an ‘I don’t need to tell’ attitude, is sailing extremely close to the wind ! Some doctors, were unhappy about that guidance – but ‘we are God’ is not the majority position, these days.

    A patient may refuse an 'open discussion' but it must be offered !

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