1. Olson, DaiWai M.

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Napoleon Bonaparte1 is credited with saying that "history is a set of lies [we have] agreed upon." This statement gives rise to the concept of an agreed-upon lie, a statement put forth as fact for which there is no real support. Agreed-upon lies come in many forms: "Ours is the best country on earth," "She is the greatest athlete in the world," and "Our stroke team has the best nurses." Often, agreed-upon lies are fairly benign. However, they are not only confined to history, national pride, sports, and our friends. The agreed-upon lie has found its way into healthcare, and the influence may be stronger than you think.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

I recently reviewed a set of articles on ventilator-associated pneumonia (VAP) and was struck by the assumptions used to support the various research studies. I would classify many of these assumptions as agreed-upon lies. For example, "Patients were maintained with the head of bed (HOB) at 30[degrees] for the duration of the study." What does this even mean? Is it possible that, during the course of a 3-week hospitalization, the HOB was never flat (even to turn the patient) and elevated?


The agreed-upon lie used in research may translate to bizarre implications in practice. Imagine that an institutional decision is made to reduce VAP. A physician reads a study where the HOB was kept at 30[degrees] and decides to implement this practice. A week later, 2 nurses are cleaning up a code-brown event (the HOB is flat). Seeing this, the physician informs management that nurses are not following the protocol. In a bizarre twist, the physician asks the nurses to defend their decision to violate the new protocol.


Facts and truth are 2 readily available tools that nurses can use to combat agreed-upon lies. First and foremost, nurses need to publish facts. In the VAP studies, what proportion of time was the HOB at exactly 30[degrees]? Is a patient turned exactly once every 120 minutes (not 123 minutes)? These are all facts that can, and should, be published. The second tool is accomplished by using our voices. The truth is that not all oral care is the same. The truth is that a heart rate of 72/min at 10:13 AM does not mean the patient's heart rate was 72/min for the entire day. These are truths and stories that also can, and should, be published.


The Journal of Neuroscience Nursing is your platform to improve care. Your experience and insight are valuable to the growth of our profession. Is it even possible to keep a patient's HOB at 30[degrees] (Fig 1)? Voice your opinion. My invitation is that I eagerly await your research report, your reflections, and your letter to the editor.

Figure 1 - Click to enlarge in new windowFIGURE 1. Is the Head of Bed Really Elevated?



1. Jeffers PH. 100 Greatest Heroes. New York, NY: Kensington Publishing Corp; 2003. [Context Link]