Managing a Patient Refusing Treatment

Scenario

You enter the room of a diabetic patient scheduled for pre-meal insulin administration.
The patient says, “No, I don’t need that — I feel fine. I don’t want insulin.”
You confirm that the blood glucose is 248 mg/dL and the patient is alert and oriented.

Question: How do you handle this situation ethically and professionally?

Best Practice Answer

1. Pause and Assess the Reason for Refusal:
   Do not react defensively or force the issue.
   Begin with curiosity and empathy:

   “Can you tell me what concerns you about taking insulin today?”
   Understanding the why helps identify barriers such as fear of needles, misunderstanding of insulin’s role, or past negative experiences.

2. Assess Capacity and Ensure the Patient Is Informed:
   Confirm that the patient is alert, oriented, and capable of making informed decisions.

   • If cognitive impairment or confusion is suspected, further assessment is needed before accepting refusal.
   • If capacity is intact, the patient has the right to refuse treatment — this must be respected.

3. Provide Clear, Factual Education:

   • Explain the purpose of insulin: to manage blood glucose and prevent complications like ketoacidosis or hyperosmolar crisis.
   • Use simple, non-threatening language:

     “Your blood sugar is higher than the safe range. Insulin helps prevent damage to your kidneys and blood vessels, even if you don’t feel symptoms right now.”

   • Clarify common misconceptions (e.g., insulin is not a punishment or sign of disease worsening).

4. Offer Choices and Collaborate:
   Empower the patient:

   • Ask, “Would you like to wait until after you eat?” or “Would you prefer I check your sugar again in 30 minutes?”
   • Small choices can improve cooperation while maintaining safety.
   • Avoid confrontation — never threaten or guilt the patient.

5. Notify the Provider:
   Inform the attending provider promptly that the patient refused medication.

   • The provider may choose to reassess, alter the insulin regimen, or document the decision.
   • Include your assessment and patient education details in the report.

6. Document Objectively and Thoroughly:

   • Record:
     • Time and details of the refusal.
     • Patient’s stated reason.
     • Education provided.
     • Provider notification and response.
   • Example:

     “Patient refused pre-meal insulin, stating, ‘I feel fine.’ Educated on importance of insulin in BG control. Provider notified; will continue to monitor.”

7. Continue Supportive Monitoring:

   • Maintain a therapeutic relationship — continue rounding and monitoring for signs of hyperglycemia.
   • Reapproach later if appropriate — refusal is situational and may change after reassurance.

Real-World Application

This scenario tests your ability to balance ethical respect for patient autonomy with clinical responsibility.
Interviewers look for nurses who:

• Stay calm and nonjudgmental,
• Provide accurate education,
• Communicate and document effectively, and
• Know when to escalate appropriately.

This skill is essential in med-surg, telemetry, psych, and chronic disease management roles.

Tip: In interviews, say —
“I’d assess understanding, educate calmly, respect autonomy, and document the refusal with provider notification.”
This response shows empathy, legal awareness, and mature communication — all hallmarks of safe nursing practice.