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Andrew Pollack-Gray

Nursing Notes

Patient Refusal of Care

3 min read

Patient Needs

Patients generally have the right to refuse care or treatment, even when refusal may affect their health.
Common reasons for refusal:

  • Pain, discomfort, or fatigue.
  • Fear, embarrassment, or anxiety.
  • Cultural, religious, or personal preferences.
  • Confusion, dementia, or communication difficulties.
  • Desire for independence or control.

What Should I Assess?

  • What care is being refused?
  • Why might the patient be refusing?
  • Is the patient experiencing pain, distress, or confusion?
  • Does the patient understand what is being offered?
  • Are there communication barriers or unmet needs

How Do I Provide Care?

  1. Respect: Stop or pause the care being refused. Remain calm and respectful.
  2. Understand: Ask why the patient does not want the care.
  3. Explain: Briefly describe the purpose of care within your scope.
  4. Adapt: Offer appropriate alternatives, choices, or a different time.
  5. Report: Notify the nurse of refusals according to policy, especially when safety is at risk.
  6. Document: Record the refusal and relevant observations as required.

Safety & Precautions

  • Never force, threaten, shame, or coerce a patient.
  • Do not assume dementia automatically removes the right to make decisions.
  • Respect the patient’s autonomy while maintaining immediate safety.
  • Do not independently determine decision-making capacity.
  • Follow care plans, facility policy, and applicable consent requirements.

Refusal of Care: Safety & Escalation

Routine Refusal

  • Respect the resident’s decision; do not force or coerce care.
  • Ask about discomfort, concerns, or preferences.
  • Offer appropriate alternatives or another time when reasonable.
  • Report the refusal according to facility policy.
  • Document the care as refused or not completed, rather than recording it as performed.

Refusal With Immediate Safety Concerns

  • Recognize concerning symptoms, such as severe breathing difficulty, chest pain, sudden confusion, or significant bleeding.
  • Summon nursing assistance immediately and activate emergency response when indicated.
  • Explain what you are doing calmly and respectfully.
  • Do not independently determine decision-making capacity or override a resident’s refusal.
  • Follow licensed staff direction and applicable consent, emergency, and facility procedures.

Important: A refusal does not automatically establish that a resident lacks decision-making capacity. Likewise, a diagnosis of dementia does not automatically invalidate a resident’s wishes.

What Should I Report?

  • Refusal of essential care, nutrition, hydration, or treatment.
  • Repeated refusals affecting health or hygiene.
  • New confusion, pain, distress, or behavioral changes.
  • Concerns about the patient’s ability to understand or communicate.
  • Any immediate safety risks.

Sources

Flashcards

What should a CNA do if a resident refuses care?03-application / patient-care
Answer

Respect refusal, ensure safety, and report per policy.

Can a CNA force routine care because it is in the care plan?03-application / patient-care
Answer

No; respect resident rights and escalate concerns appropriately.

What should a CNA do if a resident refuses care while showing signs of a medical emergency?03-application / patient-care
Answer

Respect consent, summon urgent help, and follow emergency procedures without independently overriding refusal.

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