No one should be subject to treatment that they do not wish to receive, but there is more to the story than just refusing treatment.
As nurses, we are taught to take every step necessary to save a life. We are also trained to respect the patient’s wishes. Sometimes, these two tenets conflict, and this leaves the ethical nurse in a quandary as to how to proceed.
The most important thing to consider in patients who refuse care is communication. You need to assure yourself – and the patient – that they understand what they are refusing, and what the consequences of that refusal mean. It is another invitation to teach the patient and to learn to accept wishes that go against your training.
Understand the Patient’s Point of View
Your first line of questioning should focus on what the patient thinks the procedure entails. You should try to get an understanding of where they are coming from and why they are making the decision. Often, it is just a communication issue that causes a patient to baulk from a treatment. Sometimes, the patient doesn’t understand what is being done to them or why they need it. This is a good opportunity to teach the patient about their condition and how the procedure will help them.
Sometimes, the patient understands just fine. They sincerely don’t agree with the procedure and don’t want it. It is important to gently explore this issue, too. Find out why they don’t want the procedure. Find out what thought process is going into the decision that they are making, and clarify the consequences of taking or refusing treatment.
The main reason patients refuse treatment is that they have concerns about it. These concerns can range from not thinking the procedure is necessary, to being afraid that it will kill them. It is important to bring these concerns to light so that you can talk to the patient about them. If the patient has a fear of a procedure or medicine, you can calmly and rationally speak to them about the side effects and risks. The patient has the right to make decisions regarding their care, but you need to ensure that decisions are informed.
Some concerns cannot be reasoned away. For instance, certain religious beliefs prevent people from taking blood products, and you would do them a disservice to attempt to talk them into it.
Of course, they should know the consequences of refusing treatment, but the refusal should be respected once you are sure that it is an informed decision.
Negotiate an Acceptable Solution
The best outcome in this situation is that you can allay the patient’s fears and they will consent to treatment. This outcome is not always attainable though, so you can attempt to negotiate a solution with them. For instance, if a patient is scared of a surgery, you can ask the doctor to talk to them again or ask a nurse from the operating room to speak to them about how the surgery usually goes. Once you arrange for more information for the patient, they may be more willing to agree to the procedure that could save their life.
Of course, you should not try to cajole and insist that a patient have a procedure they are unsure about. The line of questioning should focus on a willingness to understand and inform, rather than a strong-armed tactic to bully the patient into compliance.
By using your communication skills and trying to see the situation from the patient’s side, you can help them overcome their fears and make the best decision possible for their care. If that decision includes refusing care, then a nurse must come to accept the decision, no matter how much you may disagree.Document this CPD