The Man Who Won't Take the Blood Thinner

Nursing Roleplay: The Man Who Won't Take the Blood Thinner

Student briefing dossier — patient refusal, roleplay

Your role

You are a nursing student on an orthopedic unit, working the evening medication pass with your preceptor. It is 8:40 p.m. Your next patient is due for a small, once-a-day injection into the belly that prevents blood clots after hip surgery. It is ordered for about four weeks, including after he goes home.

You walk in with the syringe. He is going to say no.

Your patient

Desmond Achebe, 58, is one day out from a right total hip replacement. The surgery went well. He walked to the door and back with physical therapy this afternoon and it hurt more than he expected. He has been a letter carrier for 26 years. His wife, Gloria, went home an hour ago to feed the dog.

He took the first dose this morning without much conversation — a nurse said “this is your blood thinner” and gave it while he was still groggy. He has been thinking about it all day. He has a reason for refusing. He has not told anyone what it is.

What you need to cover

• Why lying in bed after hip surgery puts him at risk for a clot, and what a clot in the leg can do.
• What this injection does, how long it lasts, and what happens after he goes home.
• What he should watch for while he is on it.
• That the decision is his.

You will not get to any of this by leading with it.

Your challenge

Desmond is not confused and he is not being difficult. He is protecting himself, and he is doing it the only way he knows. Everything you know about clot prevention is true and none of it will land until you know what he is actually afraid of. Find out first. Then explain — in his words, not yours. He sorts mail. Talk to him like he sorts mail.

The measure of success is not whether he takes the shot. It is whether he was heard, whether he understood, and whether the choice stayed his. Pressure, “the doctor ordered it,” and scare tactics will each cost you ground. Kindness buys a second chance. Pressure does not.

How the encounter moves

Ground rules

• You start the conversation. He is already in bed with the TV on.
• There is no turn limit and no timer. The scene runs to a natural resting point: he makes a decision, or you leave, or the conversation stalls.
• He will never tell you how you are doing. He does not praise, score, or coach. The only signal is whether the conversation moves — or stays stuck.
• He does not know clinical language. If you use it without explaining it, he will not ask what it means. He will go quiet.
• He can refuse. Documenting a refusal is a legitimate outcome of a real encounter — but it is not the skill being practiced.
• You will not be told in advance what he is afraid of, what shifts him, or what a good ending sounds like.

How your transcript is assessed

Finding the real reason — Did you ask, and keep asking, until you knew what was behind the no? Did you let him finish?

Explaining in his language — Did you connect the injection to what he actually wants, in words he would use, and could you answer his follow-up questions plainly?

Persuading without overriding — Did you make the case without pressure, and did you say — and mean — that the decision was his?

Your instructor will review your transcript. Be ready to discuss the moment the conversation shifted, what you did that shifted it, and where you made it worse.

Begin when you are ready

You are at the door with the syringe. Say hello.

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