It is 8:00 AM and already a flurry of activity. Care activities are being done, alarms are going off, phones are ringing, medical equipment is making different sounds and there’s the hum of the vacuum cleaner in the background. Carers are now finishing up their medication runs. Mr. Jones had been placed safely in bed. He is approached with the usual little paper cup with his morning medications. But today is different – he says:
No way, not taking those today.
Dealing with refusal is quite common in social care. When faced with someone refusing an needed part of their care, we usually respond differently in our professional brain compared to our human brain. Our professional brain thinks about their immediate or long-term safety and adherence to their care plans. It often worries about potential health risks or complications if they don’t get what has been prescribed for them. And it can automatically push back, saying something like ‘But you have to take them’. Our human brain simply feels, and, more often than not, empathises.
Let’s first remember the golden rule of Trauma-Informed Practice: behaviour (in this case, refusal) is a form of communication. There is no better way to illustrate this than refusing medication. Saying ‘no’ or refusing medication is often not about the pill. It could be many other things unrelated to the pill itself. We just need to discover what it could be. When refusing, the person may simply be looking for control over their environment at that moment. They may feel threatened or feel overwhelmed with what’s happening around them. If that’s the case, then forcing the pill is only likely to exacerbate the problem. For Safe handling of medication, visit https://www.tidaltraining.co.uk/health-and-social-care-courses/safe-handling-of-medication-training
The best thing we can do in such situations is not to argue back but ask, gently and without leading, what might be causing the issue. A good trick here is to put your detective hat on and think to yourself: ‘Something must be bothering this resident. What could it be?’ Put the medication hat aside and try the detective hat instead. Ask open-ended, gentle questions such as ‘Is the pill tasting bad or are you feeling down?’. ‘Have you been dizzy or nauseous lately?’.
Remember that a flat-out ‘no’ should remain a ‘no’, in order to respect the resident’s autonomy. Remember, you are not a legal or moral authority figure in their life and care workers should never act in the same way that police officers act towards a legal suspect. Yes, they might be frail but, despite this, it is still illegal and morally wrong to force treatment on them. If they have clearly said ‘no’, we should respect that, as it preserves their autonomy and respects their human right to refuse treatment. That leaves us with the important job of ensuring their dignity.
