Where are the children? An autoethnography of deception in dementia in an acute hospital

Abstract

An acute hospital environment is a confusing place for many patients requiring admission, especially when they are presenting as acutely unwell. This can be particularly difficult for people living with dementia. As cognition changes it is not uncommon for people living with dementia to have difficulties with their ability to orientate to time, place and person. These disorientating moments can lead to personal distress, and at times behavioural changes. As well as being distressing for the person living with dementia, it can also be emotionally and ethically challenging for acute hospital staff; including nurses. One area found to be particularly challenging is the concept of whether actively engaging with a person living with dementia’s living truth is deceitful. This raises further questions of what forms of nurse responses to temporal disorientation might be constituted as a lying, colluding, or alternatively validating. This article uses autoethnography as a research methodology in which to explore a mental health nurse’s lived experience of the challenges of responding truthfully to disorientation and distress in an acute hospital. This article is not attempting to offer conclusive answers to these challenging ethical questions. It is instead re-opening and re-visiting the discourse of what is truth in dementia from a personal and professional nurse perspective through a lived narrative. The conclusion to the concept of truth in dementia is complex, nuanced and individualised. However, it is essential that a nurse’s response to disorientation and distress is always ‘person focused’, and not ‘lie focused’.