The patient who refuses nursing care.
OBJECTIVE
The aim of this paper is to examine the way in which nurses manage patients who refuse nursing care procedures.


METHODS
This paper reports on a qualitative study which was undertaken to explore the way in which nurses obtain consent prior to nursing care procedures. Focus groups were carried out to obtain background data concerning how consent is obtained. Critical incidents were collected through in depth interviews as a means of focusing on specific incidents in clinical practice.


METHODS
Two teaching hospitals in England.


METHODS
Purposive sample of qualified nurses.


RESULTS
When a patient refuses nursing care, nurses respond by giving information until the patient finally accedes to the procedure. Nurses will go to great lengths to achieve patients' agreement to the procedure, but the extent to which the agreement remains voluntary cannot be ascertained by the data collected in this study. If the patient does not eventually agree to a procedure, there is evidence that nurses will administer the care in the absence of consent.


CONCLUSIONS
Nurses are concerned to obtain the patient's consent prior to the administration of nursing care but if this cannot be achieved do not regard obtaining consent as an absolute requirement. Consent is preferred, but not considered essential. Nurses have some understanding of the principles of informed consent but do not apply them to everyday clinical nursing practice.
School of Health and Social Care, Oxford Brookes University, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. haveyard@brookes.ac.uk
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D001291:Attitude of Health Personnel; D002755:Choice Behavior; D006801:Humans; D007258:Informed Consent / Q000941:ethics* / Q000523:psychology; D028681:Moral Obligations; D009723:Nurse-Patient Relations; D009732:Nursing Care / Q000941:ethics* / Q000523:psychology; D010353:Patient Education as Topic / Q000941:ethics* / Q000379:methods; D028701:Patient Rights; D010565:Persuasive Communication; D016312:Treatment Refusal / Q000941:ethics* / Q000523:psychology