2022 Winter GAPNA Newsletter Volume 41 Number 4

Responding to Patient Refusal

By Georgia Reiner

Some patients may stop taking medications or refuse vaccines for their children. It is up to nurses and nurse practitioners to give the best medical advice, education, and information to patients who do disagree with medical treatments.

However, Patients will make the best decision for themselves or their family members no matter how much information they receive. Providing the information is critical to help the patient make an informed decision and reduce legal risk.

Offer Information

Nurses should educate patients in their first language with evidence-based research or studies supporting the claim. Full disclosure on medications is also crucial, including side effects when on the medication and abruptly stopping. Provided information, and translation services, should be documented in the patient’s health record, including the patient’s confirmed understanding of the material.

Shared-Decision Making

Shared-decision making (SDM) is where clinicians and patients discuss and make decisions. The clinician and patient agree with tests, treatments, and care plans based on clinical evidence while balancing the patient’s preferences.

AHRQ’s SHARE approach:

  • Step 1: Seek your patient’s participation.
  • Step 2: Help your patient explore and compare treatment options.
  • Step 3: Assess your patient’s values and preferences.
  • Step 4: Reach a decision with your patient.
  • Step 5: Evaluate your patient’s decision.

Read more about AHRQ’s SHARE Approach.

When a Patient Refuses Care

Patients can refuse treatments and diagnostic testing and leave the hospital against medical advice. Here are recommendations to reduce patient harm risk and possible legal action.

  • Measure the patient’s capacity to make decisions.
  • Listen to the patient’s reasons for refusing care.
  • Document the details of the decision.
  • Continue to provide care aside from the refused treatment.
  • Request the patient sign a form acknowledging their refusal of medical advice.
  • Stay calm and professional.

Information was adapted from the NSO article “When the patient disagrees” by Georgia Reiner, MS, CPHRM, Risk Analyst at NSO.

See NSO’s full article