AimsTo explore the experiences, and perceptions of nurses who are told to withhold clinical information from children diagnosed with serious illnesses.DesignAn interpretative qualitative phenomenological design was used for the study. Sampling was purposive and data were collected using semi‐structured interviews from nurses working in a paediatric setting within the preceding 5 years. Nurse‐participants described their personal experiences of withholding situations (‘non‐disclosure directives’). Their accounts of specific examples of situations (‘personal accounts’) were extracted from the interview transcripts and analysed using inductive content analysis to identify patterns and concepts within the descriptions. Data management was supported using Dedoose.SettingNurse‐participants were interviewed face‐to face and online between November 2019 and December 2020.ParticipantsTwenty‐six Australian nurses who have cared for seriously ill children within the preceding 5 years participated in the study.ResultsThirty‐nine accounts of non‐disclosure situations (personal accounts) were extracted from interview transcripts. Four types of non‐disclosure were identified in the personal accounts: withholding information, temporary withholding, lying and combined withholding/lying. The inductive content analysis identified three key aspects of nurse‐participants' accounts: beliefs and perceptions (about the child and parents), the nature of the experience and feelings about the experience.DiscussionMoral distress occurred when nurses' actions conflicted with their moral values in response to a non‐disclosure directive, particularly when asked to directly lie to children. Nurses felt disempowered by the parent's authority and the institutional hierarchy that limited their ability to participate in discussions where a non‐disclosure directive was given.Conclusion and ImpactNurse‐participants were afforded a platform for reflection which proved valuable in allowing them to process their experiences in a non‐disclosure situation.RecommendationsNurses directed to withhold medical information from children should be afforded opportunities for reflection to mitigate moral distress. Nurses should be included in the planning of ethically appropriate responses to withholding directives.

中文翻译：

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儿科护士被告知不要向患有严重疾病的儿童披露信息的个人叙述——一项解释性现象学研究


目的探讨护士被告知对被诊断患有严重疾病的儿童隐瞒临床信息的经验和看法。设计本研究采用了解释性定性现象学设计。抽样是有目的的，使用过去 5 年内在儿科工作的护士的半结构化访谈收集数据。护士参与者描述了他们隐瞒情况（“保密指令”）的个人经历。他们对具体情况示例（“个人叙述”）的描述从访谈记录中提取，并使用归纳内容分析进行分析，以确定描述中的模式和概念。使用 Dedoose 支持数据管理。SettingNurse-participant 在 2019 年 11 月至 2020 年 12 月期间接受了面对面和在线访谈.参与者在过去 5 年内照顾过重病儿童的 26 名澳大利亚护士参与了这项研究。结果从访谈记录中提取了 39 个保密情况的描述（个人描述）。在个人账户中发现了四种类型的保密行为：隐瞒信息、临时隐瞒、撒谎和联合隐瞒/撒谎。归纳内容分析确定了护士参与者账户的三个关键方面：信念和看法（关于孩子和父母）、经历的性质和对经历的感受。讨论当护士的行为与他们的道德价值观相冲突以响应保密指令时，特别是当被要求直接对儿童撒谎时，就会发生道德困扰。 护士们感到父母的权威和机构等级制度剥夺了她们的权力，这限制了她们参与下达保密指令的讨论的能力。结论和影响护士参与者获得了一个反思平台，事实证明，这很有价值，可以让他们在不披露的情况下处理自己的经历。建议应为被指示向儿童隐瞒医疗信息的护士提供反思的机会，以减轻道德困扰。护士应参与对扣留指令的道德适当响应的规划。