A 56-year-old patient scheduled for an elective hip replacement tomorrow tells the nurse, "I have changed my mind. I do not want this surgery." The patient is alert and oriented. Which is the nurse's most appropriate response?

A competent adult patient has the right to refuse any treatment, including a planned surgery, at any time before it begins. Informed consent must be voluntary and may be withdrawn. The nurse's role is to listen non-judgmentally, address concerns through teaching, ensure the patient understands the risks and benefits, notify the surgeon so consent and plans can be reconciled, and document the refusal, the patient's reasoning, decisional capacity, and any teaching. Choice 1 (reassuring and pressuring) violates autonomy. Choice 2 (proceeding because family wants it) violates autonomy and is a legal liability. Choice 4 (delaying the conversation for OR scheduling) prioritizes workflow over the patient's right to decide.

In-depth explanation

A competent adult patient has the right to refuse any treatment, including life-sustaining therapy, at any time. Refusal must be informed, voluntary, and free from coercion. Surrogate decision-makers may consent only when the patient lacks capacity, and refusal of one element does not waive other care. The nurse responds by listening non-judgmentally, exploring concerns, addressing misinformation through teaching, verifying decisional capacity, notifying the provider, and documenting the patient's exact words, reasoning, capacity assessment, teaching provided, and outcome — never pressuring, dismissing, or proceeding without consent. Decisional capacity is task-specific: the patient understands the diagnosis, the proposed treatment, the alternatives, and the risks of refusal, and can communicate a stable choice. A psychiatric diagnosis or anxiety alone does not remove capacity. Capacity assessment is a clinical judgment supported by structured conversation.

Clinical scenario

<p>A <strong>56-year-old patient</strong> scheduled for an <strong>elective hip replacement tomorrow</strong> tells the nurse, "<em>I have changed my mind. I do not want this surgery.</em>" The patient is <strong>alert and oriented</strong>.</p>

Key concepts

• Right to Refuse — A competent adult patient may refuse any treatment, even life-sustaining therapy, at any time. Refusal must be informed, voluntary, and free from coercion. Surrogate decision-makers may consent only when the patient lacks capacity. Refusal of one element does not waive other care.
• Nurse's Role with Refusal — Listen non-judgmentally; explore concerns; address misinformation through teaching; verify decisional capacity; notify provider; document the patient's exact words, reasoning, capacity assessment, teaching provided, and outcome. Do not pressure, dismiss, or proceed without consent.
• Decisional Capacity — Capacity is task-specific: the patient understands the diagnosis, the proposed treatment, alternatives, risks of refusal, and can communicate a stable choice. A psychiatric diagnosis or anxiety does not by itself remove capacity. Capacity assessment is a clinical judgment supported by structured conversation.