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.
Aged care system suffering. (2004). AustralianNursing Journal, 12(4), 8.
2.
Anderson, R., Ammarell, N., Bailey, D., Colón-Emeric, C., Corazzini, K., Lillie, M., et al. (2005). Nurse assistants' mental models: Sensemaking, care actions, and consequences for nursing home residents. Qualitative Health Research, 15, 1006-1021.
3.
Appleton, C. (1993). The art of nursing: The experience of patients and nurses. Journal of Advanced Nursing, 18, 892-899.
4.
Barnes, J. (1994). A pack of lies: Towards a sociology of lying. Cambridge, UK: Cambridge University Press.
5.
Beauchamp, T., & Childress, J. (2001). Principles of biomedical ethics (5th ed.). New York: Oxford University Press.
6.
Begley, C. (1999). Student midwives' views of “learning to be a midwife” in Ireland. Midwifery, 15(4), 264-273.
7.
Berger, P., & Luckmann, T. (1966). The social construction of reality: A treatise in the sociology of knowledge. London: Penguin.
8.
Blumer, H. (1969). Symbolic interactionism: Perspectives and method . Englewood Cliffs, NJ: Prentice Hall.
9.
Bok, S. ( 1973). Lying: Moral choices in public and private life. New York: Quartet.
10.
Brewin, T. (1977). The cancer patient: Communication and morale. British Medical Journal, 2, 1627.
11.
Charmaz, K. (1990). “Discovering” chronic illness: Using grounded theory. Social Science & Medicine, 30(11), 1161-1172.
12.
Charmaz, K. (2003). Qualitative interviewing and grounded theory analysis . In J. Holstein & J. Gubrium (Eds.), Inside interviewing: New lenses, new concerns (pp. 311-330). Thousand Oaks, CA: Sage.
13.
Clinton, M., Edwards, H., Moyle, W., Weir, P., & Eyeson-Annan, M. (1996). Report on stress in nurses caring for residents with Alzheimer's disease in a dementia unit. Brisbane, Australia: Queensland University of Technology, Centre for Mental Health Nursing Research.
14.
Colón-Emeric, C., Ammarell, N., Corazzini, K., Lekan-Rutledge, D., Piven, M., Utley-Smith, Q., et al. (2006). Patterns of medical and nursing staff communication in nursing homes: Implications and insights from complexity science. Qualitative Health Research, 16, 173-188.
15.
Commonwealth Department of Health and Ageing (2002). Aged care in Australia . Canberra: Author. Retrieved July 9, 2003, from http://www.health.gov.au/acc/about/agedaust/agedaust.htm
16.
Crotty, M. (1998). The foundations of social research: Meanings and perspectives in the research process. St Leonards, Australia: Allen & Unwin.
17.
Cutcliffe, J., & McKenna, H. (2002). When do we know what we know?: Considering the truth of research findings and the craft of qualitative research. International Journal of Nursing Studies, 39, 611-618.
18.
Demin, E. (1997). Communication with the breast cancer patient: An opinion from Russia. In A. Suborne & M. Zwitter (Eds.), Communication with the cancer patient: Information and truth (pp. 485-495). New York: New York Academy of Sciences.
19.
Downs, M. (1999). How to tell?: Disclosing a diagnosis of dementia [Electronic version]. Generations, 23(3), 30-34.
20.
Edwards, H., Gaskill, D., Morrison, P., Saunders, F., & Forster, E. (1999). Maximising independence and autonomy for vulnerable older people in a residential setting: Facilitating best practice. Unpublished manuscript, Queensland University of Technology: School of Nursing, Brisbane, Australia.
21.
Edwards, H., Weir, D., Clinton, M., & Moyle, W. (1993, May). Communication between residents and nurses in a dementia facility: An issue quality of life. Paper presented at the Alzheimer Association (Australia) Third National Conference , Hilton on the Park, Melbourne, Australia.
22.
Ezzy, D. (2002). Qualitative analysis: Practice and innovation. Crows Nest, Australia: Allen & Unwin.
23.
Farmer, T., Robinson, K., Elliott, S., & Eyles, J. (2006). Developing and implementing a triangulation protocol for qualitative health research. Qualitative Health Research , 16, 377-394.
24.
Faulkner, A. (1980). Communication and the nurse. Nursing Times, 76, 93-95.
25.
Fiveash, B. (1998). The experience of nursing home life. International Journal of Nursing Practice, 4, 166-174. Glaser, B. (1999). The future of grounded theory. Qualitative Health Research, 9, 836-845.
26.
Glaser, B., & Strauss, A. (1965). Awareness of dying. Chicago : Aldine.
27.
Gottesman, L., & Bourestom, N. (1974). Why nursing homes do what they do. The Gerontologist, 14, 501-506.
28.
Grbich, C. (1999). Qualitative research in health: An introduction. St. Leonards, Australia: Allen & Unwin.
29.
Guba, E., & Lincoln, Y. (1989). Fourth generation evaluation. London: Sage.
30.
Hak, T. ( 1994). The interactional form of professional dominance. Sociology of Health and Illness, 16(4), 469-488.
31.
Harper Ice, G. (2002). Daily life in a nursing home: Has it changed in 25 years?Journal of Aging Studies, 16, 345-359.
32.
Hebert, P. (1994). Truth-telling in clinical practice. CanadianFamily Physician, 40, 2105-2113.
33.
Higginbotham, N., Albrecht, G., & Connor, L. (2001). Health social science: A transdisciplinary and complexity perspective. South Melbourne, Australia: Oxford University Press.
34.
Higgs, R. (1998, September). On telling patients the truth. Paperpresented at the 11th National Bioethics Conference, Wahroonga, Australia.
35.
Inquiry calls for higher wages. (2005). Australian Nursing Journal, 13(2), 7.
36.
Johnstone, M.-J. (2004). Bioethics: A nursing perspective (4th ed.). New York: Harcourt Brace.
37.
Kaakinen, J. (1992). Living with silence. The Gerontologist , 32, 258-264.
38.
Keck, V., & Walther, L. (1977). Nurses encounters with dying and non-dying patients . Nursing Research, 26, 465-469.
39.
Keith, J. (1994). Consequences for research procedures. In J. Gubrium & A. Sankar (Eds.), Qualitative methods in aging research (pp. 105-119). London: Sage.
40.
Kendall, M. (1995). Truth-telling and collusion: The ethical dilemmas of palliative nursing. International Journal of Palliative Care, 1(3), 160-164.
41.
Kerridge, I., Lowe, M., & McPhee, J. (2005). Ethics and law for health professionals (2nd ed.). Katoomba, Australia: Social Science Press.
42.
Knight, M., & Field, D. (1981). A silent conspiracy: Coping with dying patients on an acute surgical ward. Journal of Advanced Nursing, 6, 221-229.
43.
Kvale, S. (1983). The qualitative research interview: A phenomenological and hermeneutical mode of understanding. Journal of Phenomenological Psychology, 14(2), 171-196.
44.
Lavit, G. (1988). Truth-telling to patients with a terminal diagnosis . Journal of Halacha and Contemporary Society, 15, 95-124.
45.
Legge, K. (2004, August 12). Nursing home staff numbers are “dangerously” inadequate. The Australian, p. 4.
46.
Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. London : Sage.
47.
May, C. ( 1990). Research on nurse-patient relationships: Problems of theory, problems of practice. Journal of Advanced Nursing , 15, 307-315.
48.
May, W. ( 1994). The virtues in a professional setting. In K. Fulford, G. Gillett, & J. Soskice (Eds.), Medicine and moral reasoning (pp. 75-90). Cambridge, UK: Cambridge University Press.
49.
McCormack, B. (2003). A conceptual framework for person-centred practice with older people. International Journal of Nursing Practice ; 9, 202-209.
50.
Mead, G. (1934). Mind, self, and society. Chicago : University of Chicago Press.
51.
Miles, M., & Huberman, A. (1994). An expanded source book: Qualitative data analysis (2nd ed.). London: Sage.
52.
Morgan, D. (1988). Focus groups as qualitative research. Newbury Park, CA: Sage.
53.
Morgan, D., & Spanish, M. (1984). Focus groups: A new tool for qualitative research. QualitativeSociology, 7(3), 253-270.
54.
Morris, D., & Columbia, W. (1982). Truth telling in medicine. Journal of the American Medical Association (Letters), 247(19), 2659.
55.
Morrison-Beedy, D., Cote-Arsenault, D., & Fischbeck Feinstein, N. (2001). Maximising results with focus groups: Moderator and analysis issues. Applied Nursing Research, 14(1), 48-53.
56.
Morse, J. (1991). Strategies for sampling. In J. Morse (Ed.), Qualitative nursing research: A contemporary dialogue (pp. 127-145). London: Sage.
57.
Morse, J. (1999). Qualitative generalizability. Qualitative Health Research, 9, 5-6.
58.
Moutsopoulus, L. (1984). Medicine and law. New York : Springer-Verlag.
59.
Nesvadba, C. (2003). Guide for choosing your pathway to nursing practice in Queensland. Retrieved July, 4, 2006, from http://www.qnc.qld.gov.au/upload/pdfs/Guide_for_Choosing_Your_Pathway_to_Nursing_in_Queensland.pdf
60.
New classification structure and rates of pay for nurses in aged care: Report on findings of the Queensland Industrial Relations Commission (QIRC). (2002). Queensland Nurse, 21(2), 9-11.
61.
Nussbaum, J., Pecchioni, L., & Crowell, T. (2001). The older patient—healthcare provider relationship in a managed care environment. In M. Hummert & J. Nussbaum (Eds.), Aging, communication & health: Linking research and practice for successful aging (pp. 23-42). London: Lawrence Erlbaum .
62.
Parathian, A., & Taylor, F. (1993). Can we insulate trainee nurses from exposure to bad practices?: A study of role play in communicating bad news to patients . Journal of Advanced Nursing, 18, 801-807.
63.
Paterson, J., & Zderad, L. (1976). Humanistic nursing. New York : John Wiley.
64.
Rice, P.L., & Ezzy, D. (2000). Qualitative research methods: A health focus. South Melbourne, Australia: Oxford University Press.
65.
Rosner, F., Berger, J., Kark, P., Potash, J., & Bennett, A. (2000). Disclosure and prevention of medical errors. Archives ofInternal Medicine, 160(14), 2089-2092.
66.
Schatzman, L., & Strauss, A. (1973). Field research. Englewood Cliffs, NJ: Prentice-Hall.
67.
Serghis, D. (1998). QNU survey uncovers aged care woes [Electronic version]. Australian Nursing Journal, 6(5), 9. Shaughnessey, P. (1989). Quality of nursing home care. Generations, 13, 17-20.
68.
Sheldon, M. (1982). Truth telling in medicine. Journal of theAmerican Medical Association, 247(5), 651-654.
69.
Sidgwick, H. (1966). The methods of ethics. New York: Dover.
70.
Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage.
71.
Survey reveals aged-care crisis. (1998). Australian Nursing Journal, 6(4), 6.
72.
The, A.-M., Hak, T., Koeter, G., & van der Wal, G. (2006). Collusion in doctor-patient communication about imminent death: An ethnographic study. British Medical Journal, 321, 1376-1381.
73.
Thorman Hartig, M. (1998). Expert nursing assistant care activities. Western Journal of Nursing Research, 20(5), 684-601.
74.
Tuckett, A. (1998). “Bending the truth”: Professionals' narratives about lying and deception in nursing practice. International Journal of Nursing Practice, 35, 292-302.
75.
Tuckett, A. (2000). Virtuous principles as an ethic for nursing. Contemporary Nurse, 9(2), 106-114.
76.
Tuckett, A. (2004a). Qualitative research sampling: The very real complexities. Nurse Researcher, 12(1), 47-61.
77.
Tuckett A. (2004b). Truth-telling in aged care: A qualitative study . Doctoral dissertation, Queensland University of Technology . Retrieved July 17, 2005, from http://adt.library.qut.edu.au/adt-qut/public/adt-QUT20040827.093416
78.
Tuckett, A. (2004c). Truth-telling in clinical practice and the arguments for and against: A review of the literature. NursingEthics , 11(5), 500-513.
79.
Tuckett, A. (2005a). Applying thematic analysis theory to practice: A researcher's experience. Contemporary Nurse, 19(1/2), 75-87.
80.
Tuckett, A. (2005b). The care encounter: Pondering caring, honest communication and control. International Journal of Nursing Practice, 11, 77-84.
81.
Tuckett, A. (2005c). Part II—Rigour in qualitative research: Complexities and solutions. Nurse Researcher, 13(1), 29-42.
82.
Tuckett, A. (2005d). Residents' rights and nurses' ethics in the Australian nursing home. International Nursing Review, 52, 219-224.
83.
Tuckett, A., & Stewart, D. (2003/2004). Collecting qualitative data, part I: Journals as method—Experience, rationales and limitations. Contemporary Nurse, 16(1/2), 104-113.
84.
Tuckett, A., & Stewart, D. (2004). Collecting qualitative data, part II: Group discussion as method—Experience, rationales and limitations. Contemporary Nurse, 16(3), 240-251.
85.
Van der Heide, G. (2001, August). Qualitative analysis issues. Paper presented at the Seventh International Health Summer School, Expanding New Horizons in Public Health, Qualitative Research Methods for Public Health Seminar, Queensland University of Technology, Brisbane, Australia.
86.
Wilkinson, S. (1999). Focus groups: A feminist method. Psychology of Woman Quarterly, 23, 221-244.
87.
Wood, L., & Kroger, R. (1993). Forms of address: Discourse and aging. Journal of Aging Studies, 7(3), 263-277.
88.
Wright, L., MacRae, S., Gordon, D., Elliot, E., Dixon, D., & Abbey, S. (2002). Disclosure of misattributed paternity: Issues involved in the discovery of unsought information. Seminars in Dialysis, 15(3), 202-206.
89.
Yates, P., Dewar, A., & Fentiman, B. (1995). Pain: the views of elderly people living in long-term residential care settings. Journal of Advanced Nursing, 21(4), 667-674.
