Original Article

White lies in pediatric care: a qualitative study from nurses’ perspective


Communication and sharing information with ill children are challenging. To protect a child from the bitter reality, sometimes use of well-intended untruths, or white lies is necessary. This research aimed at studying the experiences of nurses about the use of white lies in in pediatric clinical setting.
In this qualitative, content-analysis study, 24 on-duty pediatric nurses were interviewed in 2019. Data were collected through purposeful sampling using semi-structured interviews, and the collected data were analyzed according to Granheim and Landman’s method using MAXQDA-10 software.
Eighteen female and six male nurses with the mean age of 42 ± 3/7 years and mean work experience of 16 ± 4/1 years were selected to participate in this study. Data analysis showed that use of white lies depends on both situation and several other factors classified into five general categories: nature of data, childhood characteristics, family norms, treatment team’s capabilities and organization policies.Treatment team members need to improve their communication skills to convey therapeutic information to the ill child’s family appropriately. To do so, special guidelines should be prepared for healthcare staff in pediatric clinical setting.

- Birnie K, Noel M, Parker J, et al. Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. J Pediatr Psychol. 2014; 39(8): 783-808.

Gough J, Johnson L, Waldron S, Tiler P, Donath S. Clinical communication: innovative education for graduate nurses in pediatrics. Nurse Edu Pract. 2009; 9(3): 209-14.

H Habibzadeh, K Ghorbanzadeh, HR Khalkhali, Y Mohamadpor. Study of relationship between quality of work life and nursing clinical competency. Nursing and Midwifery Journal. 2012;10(3):0-0.

Klakovich MD, Dela Cruz FA. Validating the interpersonal communication assessment scale. J Prof Nurs. 2006; 22(1): 60-7.

Rosenberg AR, Starks H, Unguru Y, Feudtner C, Diekema D. Truth telling in the setting of cultural differences and incurable pediatric illness. JAMA Pediatr. 2017; 171(11): 1113-9.

Parsons S, Saiki-Craighill S, Mayer D, et al. Telling children and adolescents about their cancer diagnosis: cross-cultural comparisons between pediatric oncologists in the US and Japan. Psychooncology. 2007; 16(1): 60-8.

Jafarey A, Farooqui A. Informed consent in the Pakistani milieu: the physician’s perspective. Journal of Medical Ethics. 2005; 31: 93-6.

Bou-Khalil R. Attitudes, beliefs and perceptions regarding truth disclosure of cancer-related information in the Middle East: a review. Palliat Support Care. 2013; 11(1): 69-78.

Silbermann M, Hassan EA. Cultural perspectives in cancer care: impact of Islamic traditions and practices in Middle Eastern countries. J Pediatr Hematol Oncol. 2011;33(Suppl.2):81-6.

Hasselkus BR. Everyday ethics in dementia day care: narratives of crossing the line. The Gerontologist. 1997; 37(5): 640-9.

Nikbakht-Nasrabadi A, Joolaee S, Navvab E, Esmaeilie M, Shali M. A concept analysis of white lie from nurses’ perspectives: a hybrid model. Hayat. 2019; 25(3): 309-24.

James IA, Wood-Mitchell AJ, Waterworth AM, Mackenzie LE, Cunningham J. Lying to people with dementia: developing ethical guidelines for care settings. Int J Geriatr Psychiatry. 2006; 21(8): 800-1.

Hekmat-Afshar M, Jooybari L, Sanagou A, Kalantari S. Study of factors affecting moral distress among nurses: a review of previous studies. J Educ Ethics Nurs. 2013;1(1): 0-0.

Fazljoo E, Borhani F, Abbaszadeh A, Dadgari A. Assessment of moral reasoning ability of the nurses in dealing with moral dilemmas. Medical Ethics. 2016; 10(36): 47-54.

Hudson N, Spriggs M, Gillam L. Telling the truth to young children: ethical reasons for information disclosure in paediatrics. J Paediatr Child Health. 2019; 55(1):13-7.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2): 105-12.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-88.

Mack JW, Joffe S. Communicating about prognosis: ethical responsibilities of pediatricians and parents. Pediatrics. 2014;133(Suppl.1): S24-30.

Atesci FC, Baltalarli B, Oguzhanoglu NK, Karadag F, Ozdel O, Karagoz N. Psychiatric morbidity among cancer patients and awareness of illness. Support Care Cancer. 2004; 12(3): 161-7.

Bozo O, Anahar S, Ateş G, Etel E. Effects of illness representation, perceived quality of information provided by the health-care professional, and perceived social support on depressive symptoms of the caregivers of children with leukemia. J Clin Psychol Med Settings. 2010; 17(1): 23-30.

Rosenberg AR, Wolfe J, Wiener L, Lyon M, Feudtner C. Ethics, emotions, and the skills of talking about progressing disease with terminally ill adolescents: a review. JAMA Pediatr. 2016; 170(12): 1216-23.

Kelly KP, Mowbray C, Pyke-Grimm K, Hinds PS. Identifying a conceptual shift in child and adolescent-reported treatment decision making: “having a say, as I need at this time”. Pediatr Blood Cancer. 2017; 64(4).

Sadat-Hoseini A, Aramesh K. Ethical challenges in pediatric end of life care. Medical Ethics. 2013; 7(25): 55-81.

Wong CA, Cummings GC, Ducharme L. The relationship between nursing leadership and patient outcomes: a systematic review update. J Nurs Manag. 2013; 21(5): 709-24.

Corlett J, Twycross A. Negotiation of parental roles within family-centred care: a review of the research. J Clin Nurs. 2006; 15(10): 1308-16.

Shields L, Nixon J. Hospital care of children in four countries. Journal of Advanced Nursing. 2004; 45(5): 475-86.

Apatira L, Boyd E, Malvar G, et al. Hope, truth, and preparing for death: perspectives of surrogate decision makers. Ann Intern Med. 2008; 149(12): 861-8.

Klein C. Respect for patients, physicians, and the truth. In: Vaughun L. Bioethics Principles, Issues, and Cases, 3rd ed. USA: Oxford University Press; 2016.

Mack JW, Wolfe J, Grier HE, Cleary PD, Weeks JC. Communication about prognosis between parents and physicians of children with cancer: parent preferences and the impact of prognostic information. J Clin Oncol. 2006; 24(33): 5265-70.

Valizadeh F, Ghasemi S. Medical staff attitude toward parents’ participation in the care of their hospitalized children. Hayat. 2008; 14(1): 69-76.

Kourkouta L, Papathanasiou IV. Communication in nursing practice. Mater Sociomed. 2014; 26(1): 65-7.

Ardoin KB, Wilson KB. Cultural diversity: what role does it play in patient safety? Nurs Womens Health. 2010; 14(4): 322-6.

Culley H, Barber R, Hope A, James I. Therapeutic lying in dementia care. Nurs Stand. 2013; 28(1): 35-9.

Mahasti Jouybari L, Ghana S, Sarrafi Kheirabadi S, Sanagoo A. The nurses' experiences of breaking bad news to the patients and their relatives. Medical Ethics. 2013; 7(24): 11-31.

Grassi L, Giraldi T, Messina EG, Magnani K, Valle E, Cartei G. Physicians' attitudes to and problems with truth-telling to cancer patients. Support Care Cancer. 2000; 8(1): 40-5.

IssueVol 13 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jmehm.v13i16.4414
Ethics; Pediatrics; Truth-telling; Content analysis.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Shali M, Joolaee S, Navab E, Esmaeili M, Nikbakht Nasrabadi A. White lies in pediatric care: a qualitative study from nurses’ perspective. J Med Ethics Hist Med. 2020;13.