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Introduction
Reflective practice is a cornerstone of professional nursing development. As indicated by Johns (2017), structured reflection enables practitioners to move beyond technical competence toward a deeper integration of experience and knowledge that enhances both care quality and professional identity. This account reflects on a clinical encounter in which a patient declined a component of their prescribed treatment plan, using Gibbs Reflective Cycle (1988) as the organising framework. To protect confidentiality in accordance with the NMC Code (2018), identifying details have been omitted and the patient is referred to as Mrs A.
Description
Mrs A, a patient in her late sixties recovering from a surgical procedure, declined to take her prescribed analgesic medication on the grounds that she preferred not to use strong painkillers. As the registered nurse responsible for her care that shift, I was required to respond to this refusal in a way that respected her autonomy whilst ensuring her comfort and recovery were not compromised. The encounter involved a discussion between myself, Mrs A, and a junior colleague, and it raised questions I had not previously considered about the tension between patient autonomy and clinical responsibility.
Feelings
My initial response was one of discomfort. I was concerned that Mrs A's refusal would impede her recovery and that I had a professional duty to encourage compliance with the prescribed plan. As observed by Tanner (2006), nurses' intuitive responses to clinical situations often reflect deeply embedded assumptions about the proper relationship between clinical expertise and patient agency, and I recognise that my discomfort partly reflected an assumption that I knew better than Mrs A what was in her interest.
Evaluation
On reflection, the encounter was ultimately positive in its outcome. Mrs A remained comfortable, her recovery proceeded without complication, and her trust in the nursing team appeared to be strengthened by the fact that her wishes were respected. According to the NMC Code (2018), nurses must respect and uphold people's human rights, and this standard is most meaningfully applied in moments of tension such as this one, where respecting rights requires active engagement rather than passive acquiescence.
Analysis
The theoretical foundation most relevant to this encounter is the principle of respect for autonomy, as articulated within the four-principle framework of Beauchamp and Childress (2019). As argued by Beauchamp and Childress, autonomy is not merely the absence of constraint but a positive capacity for self-governance that healthcare professionals are obligated to support through the provision of accurate information and the creation of conditions in which authentic choice is possible. In Mrs A's case, autonomous refusal was based on a clear understanding of the medication and its purpose; it was therefore a legitimate exercise of her rights rather than a choice made under the influence of misinformation or incapacity.
However, it is important to acknowledge a tension within the autonomy principle. As indicated by Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112, the capacity to make autonomous decisions must be assessed rather than assumed, and the healthcare professional carries a duty to ensure that the decision is genuinely informed. In this case, I provided clear information about the purpose and effects of the analgesic before accepting Mrs A's refusal, which represented a proportionate response to this duty.
Conclusion and Action Plan
This encounter has confirmed the importance of regarding patient autonomy not as an obstacle to good care but as a constitutive element of it. As noted by McCormack and McCance (2017), person-centred nursing requires practitioners to hold patients' values and beliefs at the centre of care planning and delivery. Going forward, I will approach similar situations with a clearer initial orientation toward the patient's perspective, seeking to understand their reasoning before seeking to address it. I will also discuss such encounters with my practice supervisor as part of ongoing reflective supervision, in accordance with the NMC Revalidation requirements.