Clinical placements

Nurse’s response to medicine refusal was a lesson in quality care

A nurse halted a drug round when a patient declined additional medication and took the time to explain its benefits and risks – resulting in the patient accepting it. Witnessing this incident gave Jordan Martin a greater understanding of medicines management

A nurse halted a drug round when a patient declined additional medication and took the time to explain its benefits and risks – resulting in the patient accepting it. Witnessing this incident gave Jordan Martin a greater understanding of medicines management


Picture: iStock

In my third year of training on clinical placement on a cardiology ward, I was observing a nurse administering medications to patients.

An older female patient, who I will call Mrs Brown, became upset when the nurse told her that the drug digoxin had been added to her list of prescribed medications.

Mrs Brown had recently been diagnosed with atrial fibrillation (AF), a cardiac arrhythmia which digoxin is commonly used to treat. But when the nurse tried to administer the medication, Mrs Brown said she felt fine, that there was nothing wrong and that she didn’t need the medication.

Listening to concerns

After checking that it would not compromise the safety of the other patients, the nurse put the medication round temporarily on hold to have a chat with Mrs Brown about her digoxin, and after further discussion, she agreed to take it.

I was impressed with the nurse’s compassionate response to Mrs Brown’s concerns. Instead of simply insisting she take the medication, the nurse used her knowledge of digoxin to help Mrs Brown understand the benefits of the drug and why she needed to take it for her heart condition.

Throughout the discussion, it was evident the nurse knew the therapeutic value of digoxin, as well as its risks, benefits and side effects. She conveyed empathy for Mrs Brown’s frustration at having to take additional medication, demonstrated warmth in her responses, and listened to her concerns.

Patient education

Discussing Mrs Brown’s medication with her also created an opportunity for patient education. The nurse began preparing Mrs Brown for self-administration on discharge, including specific information such as omitting a dose if her pulse rate went below 60bpm.

This nurse’s practice was an excellent example of quality care as well as safe and effective medicines management. Besides demonstrating how effective communication can strengthen the therapeutic relationship, her patient-centred approach highlighted the importance of shared decision-making in empowering patients to self-manage their conditions.

All actions by the nurse, including giving information, supporting self-monitoring and counselling, were linked to improvements in medication adherence for long-term conditions.

Value of reviews

This experience reinforced the importance of knowledge of medications and highlighted why opportunistic medication reviews should be carried out where possible to improve patient care.

It also widened my understanding of a nurse’s responsibilities regarding medicines management, and how these extend beyond safe administration to helping patients make informed decisions about their medications.

Prior to this experience, I saw medication rounds as predominantly one-sided, where the nurse administers the medications and the patient takes them.

I now appreciate how collaborative they can be, enhancing the nurse-patient relationship by providing an opportunity to check a patient’s understanding of medications and provide education, which will improve my future practice.


Jordan Martin graduated from the University of Manchester in 2017 and now works as a critical care nurse in Manchester

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