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Competent Patient Refusal of Nursing Care

An Innovative Approach to a Complex Problem

Keen, Alyson; Thoele, Kelli; Fite, Lisa; Lancaster, Shelley

Journal of Wound Ostomy & Continence Nursing: September/October 2019 - Volume 46 - Issue 5 - p 390–395
doi: 10.1097/WON.0000000000000569
Wound Care
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Pressure injury development results in significant morbidity and costs. Despite well-defined guidelines, nurses are frequently faced with subtle and overt patient resistance when implementing prevention strategies. Case law and hospital policies guide decision making when confronted with refusal of medical care; however, there are limited recommendations that guide competent patient refusal of nursing care. This article presents findings of an integrative literature review and idea-generating forum about competent patient refusal of nursing care. Emerging topics from the literature review were mirrored in responses generated during the innovation forum; responses from the forum confirmed the clinical relevance of the issue and the lack of resources to guide care in this area for approach.

Alyson Keen, MSN, RN, ACNS-BC, Nursing Quality Department, Indiana University Health, University Hospital, Indianapolis, Indiana.

Kelli Thoele, MSN, RN, ACNS-BC, BMTCN, OCN, PhD student, Robert Wood Johnson Foundation Future of Nursing Scholar, Indiana University School of Nursing, Indianapolis, Indiana.

Lisa Fite, MSN, RN, ACNS-BC, CCRN-K, Nursing Quality Department, Indiana University Health, University Hospital, Indianapolis, Indiana.

Shelley Lancaster, MSN, RN, ACNS-BC, CWOCN, CCRN-K, Nursing Quality Department, Indiana University Health, North Hospital, Carmel, Indiana.

Correspondence: Alyson Keen, MSN, RN, ACNS-BC, Nursing Quality Department, Indiana University Health, University Hospital, 550 N University Blvd, Indianapolis, IN 46202 (akeen2@iuhelath.org).

The authors confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere.

The authors declare no conflicts of interest.

© 2019 by the Wound, Ostomy and Continence Nurses Society.