Reflection on Refusal of Treatment

The purpose of this essay is to select an incident which occurred during clinical placement and to discuss and reflect on it in order to improve future practice. To do this, the framework of the Marks-Maran and Rose Model of Reflection (1997) will be used. Utilising the four stages of this model, I will describe the incident, give a reflective observation, discuss related theory and conclude with thoughts for any future actions. Any patient discussed will be given a pseudonym to ensure patient confidentiality as described by the Nursing and Midwifery Council (NMC) (2010).
During a recent placement in an Endoscopy day unit, I met Mrs Smith who was attending to undergo a Gastroscopy. She had a history of acid reflux and had been referred for the procedure as an outpatient but had not attended her Pre-Admission Clinic appointment. Upon her arrival, myself and a staff nurse took baseline observations and spoke with the patient to ensure that she had fasted from midnight which was necessary for the procedure. On advising her on anaesthesia, I informed her that she had two options. The first was a throat spray to numb the local area and she could leave almost immediately afterwards. The second was sedation and analgesia in the form of Fentanyl and Midazolam which would be given through intravenous cannulation; however, she would have to remain with us for several hours post procedure. Mrs Smith began to panic and became quite irate. She stated that she had been under the impression that she would be given a general anaesthetic and would be asleep the entire time. I explained that the doctor required her to be awake for this procedure and that general anaesthetic was not an option.
Mrs Smith then stated that she was withdrawing her consent and wished to leave. The staff nurse who had been observing me swiftly took over the conversation and attempted to calm down the patient. She advised me to escort Mrs Smith to the private seating area that was reserved for

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