Refus de soins : activités, supports et aménagements concrets à mettre en place
« Elle ne veut pas, on n'insiste pas, on repassera plus tard. » Cette phrase, entendue dans presque toutes les équipes, décrit une réalité épuisante : le refus de soins n'est pas un incident isolé, c'est un quotidien. Or, face à ce quotidien, on manque rarement de bonne volonté ; on manque de matériel prêt à l'emploi. Cet article rassemble des refus de soins : activités, outils et aménagements que vous pouvez installer dès demain, sans budget, sans réorganisation lourde, et sans transformer chaque toilette en négociation.
Dans cet article
La formation associée
Les ressources citées
Thermomètre des émotions
Décodeur d'Expressions Faciales
Cartes de conversation
Échelle de la VoixLe parti pris est volontairement concret. Pas de théorie sur les causes du refus : d'autres articles de la série s'en chargent. Ici, vous trouverez douze activités et adaptations décrites pas à pas, une routine type sur une semaine, les aménagements d'environnement qui désamorcent l'opposition avant même qu'elle apparaisse, les supports gratuits à télécharger et à afficher, et la place — mesurée — du numérique. Chaque proposition indique son objectif, le matériel, la durée, le déroulé, une variante plus simple, une variante plus exigeante et le signe concret que ça fonctionne.
L'essentiel en 30 secondes
Le refus de soins recule beaucoup plus vite avec des supports visuels, des choix cadrés et des rituels stables qu'avec de la persuasion. L'outillage compte davantage que le discours.
- Le levier n°1 — rendre le soin prévisible : annoncer, montrer, séquencer. La surprise déclenche l'opposition, la prévisibilité la désamorce.
- Le choix, pas l'ultimatum — offrir deux options acceptables (l'ordre, le moment, le professionnel) restaure un sentiment de contrôle sans céder sur le soin lui-même.
- Les émotions d'abord — un support pour nommer ce qui se passe (thermomètre, cartes) évite que la tension monte jusqu'au refus franc.
- L'environnement fait la moitié du travail — bruit, lumière, encombrement et rythme conditionnent l'acceptation avant le premier geste.
- Ce qui n'est pas écrit se perd — une fiche de préférences de dix lignes protège le lien les week-ends et à chaque remplacement.
Refus de soins : ce que les activités et les outils changent concrètement
Un refus de soins est rarement un caprice. C'est le plus souvent une réponse : à une douleur, à une peur, à une consigne mal comprise, à une perte de contrôle, à un environnement agressant. Face à cela, la persuasion verbale atteint vite ses limites — insister augmente la tension, et la tension nourrit le refus. Les activités et les outils agissent ailleurs : ils rendent le soin lisible, redonnent une prise à la personne et abaissent le niveau d'alerte avant que le geste commence.
Three mechanisms explain their effectiveness. First, the predictability: a visual support that shows the steps of the care transforms the unknown — a source of anxiety — into a known sequence. Next, the feeling of control: a choice, even a tiny one, changes the person's posture from "I am being done to" to "I am participating." Finally, the emotional regulation: naming an emotion, with an image or a card, allows it to be processed before it expresses itself in physical opposition.
These three levers have a common interest: they shift the energy from the professional. Rather than spending minutes convincing, repeating, and reassuring once the tension is established, we invest a few seconds upstream to prevent the tension from rising. It is a change in posture before being a technique: we stop reacting to refusal to prevent it. The tools described later are therefore not isolated tricks; they form a coherent system where each support prepares the next one, from the first contact to the closure of the care.
Not "how to convince her?" but "what, in the next five minutes, would make this care more predictable and leave her with at least one choice?" The shift from one question to the other radically changes the acceptance rate, without extending the care time.
A new, sudden, or unusual refusal is not always behavioral: it can signal pain, an infection, a side effect, or distress. Observing, tracing, and reporting to the healthcare professional remains the priority. The tools presented here accompany the care; they never replace a medical opinion to understand the origin of a refusal.
12 activities and adaptations to implement starting tomorrow
Each sheet indicates the objective, the material, the duration, the procedure, an easier variant, a more demanding variant, and the concrete sign that it works. None require a budget. All, however, require being shared by the team: a tool applied by a single person loses most of its interest, as it creates a treatment gap from one professional to another.
The emotion thermometer before the care
- Objective — to identify the emotional state before starting, to adapt the pace rather than force.
- Material — a ruler or a graduated poster from calm to tension, laminated, within reach.
- Duration — less than a minute.
- Procedure — present the thermometer, ask "where are you right now?", then adjust: if the level is high, we defer, lighten, or propose a break before the action.
- Easier variant — three faces only (green, orange, red) to point at.
- More demanding variant — verbalize what makes the cursor go up or down.
- Sign that it works — the person shows the cursor themselves before being asked.
- ❌ To avoid: using the thermometer and then ignoring the signal given. This teaches that the tool is useless.
The choices wheel
- Objective — to restore a feeling of control without compromising the care itself.
- Material — a wheel or an illustrated support presenting two to four acceptable options.
- Duration — thirty seconds to one minute.
- Procedure — propose a framed choice: "do we start with the face or the hands?", "now or in five minutes?". The care is non-negotiable; its modalities are.
- Easier variant — two images to point at, without words.
- More demanding variant — let the person compose the complete order of the care.
- Sign that it works — the person takes the time to choose instead of refusing outright.
- ❌ To avoid: the false choice ("do you want the toilet now or now?"), immediately unmasked and experienced as manipulation.
The visual sequencing of care
- Objective — make the care predictable by showing its steps, from beginning to end.
- Material — a strip of pictograms or photos, magnetic or velcro, in the order of care.
- Duration — the time of care ; preparation is done once and for all.
- Procedure — present the strip, announce the current step, remove or check off each image passed. The person sees what remains and especially that it ends.
- Easier variant — a maximum of three steps, very contrasted.
- More demanding variant — let the person point to the next step themselves.
- Sign that it works — the person spontaneously looks at the strip to anticipate what comes next.
- ❌ To avoid : changing the displayed order during care ; the unexpected undermines all the benefit.
The facial expression decoder
- Objective — help identify and name emotions, in oneself and in others, to prevent misunderstandings.
- Material — a support illustrating facial expressions associated with simple words.
- Duration — two to five minutes, outside of care, in a workshop or as a warm-up.
- Procedure — observe an expression, name it together, relate it to a situation. We build a reusable common vocabulary at the time of care.
- Easier variant — two opposing emotions (happy / not happy).
- More demanding variant — associate an emotion with a cause and a possible response.
- Sign that it works — the person spontaneously uses an emotion word learned.
- ❌ To avoid : turning the activity into a test (“ and this, what is it ? ”), which leads to failure.
Conversation cards
- Objective — recreate connection before care, so that the gesture is not the only interaction of the day.
- Material — a deck of cards offering prompts for exchange (memories, tastes, seasons).
- Duration — three to five minutes.
- Procedure — draw a card, exchange for a few minutes, then transition to care in continuity of the relationship, without a sudden change in tone.
- Easier variant — cards with evocative photos, without text.
- More demanding variant — the person chooses the card and initiates the exchange.
- Sign that it works — the person resumes the conversation or asks for “ their ” card.
- ❌ To avoid : rushing the exchange to “ save time ” ; it is precisely this that saves time later.
The voice scale
- Objective — regulate the sound level, a frequent source of agitation, in the person as well as in professionals.
- Material — a graduated poster from silence to loud voice, with visual markers.
- Duration — continuous ; it is an ambient marker.
- Procedure — discreetly indicate the expected level instead of saying “ quieter ”. The tool also applies to the team, which adjusts its own voice.
- Easier variant — two levels (soft voice / normal voice).
- More demanding variant — the person indicates the level that suits them.
- Sign that it works — the general tone lowers during care and transmissions.
- ❌ To avoid : raising the voice to cover noise ; this feeds exactly what we want to reduce.
The entry ritual (the “ airlock ”)
- Objective — signal that care is approaching, to avoid the element of surprise that triggers refusal.
- Material — none ; a phrase and a gesture that are always the same.
- Duration — fifteen to thirty seconds.
- Procedure — knock, introduce oneself, announce the day, the time, and what one is there to do, in a short sentence, then wait for a response, even non-verbal, before entering the intimate space.
- Easier variant — the same formula word for word each time.
- More demanding variant — let the person indicate when they are ready.
- Sign that it works — the person responds or prepares themselves upon seeing you.
- ❌ To avoid : entering while talking to a colleague over the person.
La diversion sensorielle pendant le soin
- Objectif — détourner l'attention de ce qui inquiète, sans tromper la personne.
- Matériel — musique familière, objet à tenir, serviette tiède, chanson connue.
- Durée — le temps du soin.
- Déroulé — proposer un appui sensoriel apaisant au moment du geste le plus difficile : une mélodie qui accompagne le rinçage, un objet à manipuler pendant l'habillage.
- Variante plus facile — un seul stimulus, bien connu de la personne.
- Variante plus exigeante — la personne choisit son support d'apaisement.
- Signe que ça marche — la crispation baisse au moment habituellement critique.
- ❌ À éviter : profiter de la diversion pour accélérer un geste douloureux sans le nommer ; la confiance se perd vite.
Le soin en deux temps (le report négocié)
- Objectif — sortir de l'affrontement sans renoncer au soin, quand la tension est trop haute.
- Matériel — un repère temporel visible (horloge, minuteur visuel).
- Durée — variable ; le report est court et annoncé.
- Déroulé — acter le refus du moment, fixer un rendez-vous proche et concret (« je reviens quand la grande aiguille sera là »), quitter la pièce, revenir à l'heure dite. Le respect du délai construit la confiance.
- Variante plus facile — report très court, minuteur bien visible.
- Variante plus exigeante — la personne propose elle-même l'heure du retour.
- Signe que ça marche — le soin se fait au retour, sans nouvelle escalade.
- ❌ À éviter : promettre un retour et ne pas revenir à l'heure ; le prochain report n'aura plus aucune valeur.
Le soin coopératif étape par étape
- Objectif — faire participer la personne au geste plutôt que le subir, ce qui réduit la sensation d'intrusion.
- Matériel — le matériel de soin habituel, mis en main.
- Durée — le temps du soin, à peine allongé.
- Déroulé — confier le morceau du geste que la personne peut réaliser (tenir le gant, tendre le bras, tenir le peigne), amorcer, laisser quelques secondes avant d'aider. On accompagne, on ne fait pas à la place par réflexe.
- Variante plus facile — un seul geste confié, toujours le même.
- Variante plus exigeante — enchaîner plusieurs gestes coopératifs.
- Signe que ça marche — la personne initie le geste avant qu'on le demande.
- ❌ À éviter : reprendre le geste dès la première hésitation ; le temps de latence fait partie du soin.
Le minuteur visuel
- Objectif — donner un début et surtout une fin visibles, pour rendre le soin supportable.
- Matériel — un minuteur visuel (le temps restant se voit d'un coup d'œil) ou un sablier.
- Durée — le temps du soin.
- Déroulé — poser le minuteur dans le champ de vision, annoncer « quand il n'y a plus de rouge, c'est fini ». Savoir que ça finit rend l'inconfort tolérable.
- Variante plus facile — durée très courte, découpée en plusieurs minuteurs.
- Variante plus exigeante — la personne lance elle-même le minuteur.
- Signe que ça marche — la personne surveille le minuteur au lieu de résister.
- ❌ À éviter : dépasser le temps annoncé ; l'outil ne sert qu'une fois si la promesse n'est pas tenue.
Le récapitulatif positif après le soin
- Objectif — clore sur une note positive, pour que le souvenir du soin ne soit pas seulement celui de la contrainte.
- Matériel — aucun, ou un support de valorisation simple (tableau, gommette).
- Durée — trente secondes.
- Déroulé — nommer précisément ce qui a bien fonctionné (« vous avez tenu le gant, c'était bien »), remercier, annoncer le prochain moment agréable. On ancre une trace positive pour le soin suivant.
- Variante plus facile — un geste de valorisation non verbal.
- Variante plus exigeante — demander à la personne ce qu'elle a préféré.
- Signe que ça marche — le soin suivant démarre avec moins de résistance.
- ❌ À éviter : un compliment vague et automatique ; il faut nommer un fait précis pour qu'il compte.
Une routine type sur une semaine
Un outil isolé produit peu ; c'est la régularité qui installe la confiance. L'idée n'est pas d'ajouter des activités mais de rythmer la semaine pour que la personne retrouve des repères stables. Voici une trame indicative, à adapter au public et au projet personnalisé. Elle privilégie les temps exigeants le matin, quand la disponibilité cognitive est la meilleure, et allège la fin de journée.
| Jour | Matin (avant les soins) | Après-midi | Fin de journée |
|---|---|---|---|
| Lundi | Thermomètre des émotions + rituel d'entrée | Atelier cartes de conversation | Récapitulatif positif |
| Mardi | Roue des choix sur l'ordre du soin | Décodeur d'expressions faciales en petit groupe | Musique familière |
| Mercredi | Séquençage visuel du soin | Soin coopératif étape par étape | Échange court, échelle de la voix |
| Jeudi | Thermomètre + minuteur visuel | Atelier sensoriel apaisant | Récapitulatif positif |
| Vendredi | Roue des choix + rituel d'entrée | Cartes de conversation, bilan de la semaine | Annonce du week-end |
| Week-end | Rituel d'entrée maintenu | Activités allégées, mêmes repères | Formules identiques à la semaine |
Le week-end et les remplacements. C'est précisément quand les repères sautent que le refus réapparaît. Maintenir au minimum le rituel d'entrée et les formules habituelles, même en effectif réduit, protège le travail des jours précédents. Une routine ne vaut que si elle survit aux jours où l'équipe habituelle n'est pas là.
Pour que cette routine survive aux absences, un seul document suffit : une fiche de préférences individuelle, courte, affichée ou intégrée au projet personnalisé, que tout remplaçant peut lire en une minute. Elle ne contient pas de diagnostic mais des actions immédiatement applicables. Voici une trame de dix lignes à copier et à remplir avec chaque personne concernée.
| Ligne | Exemple à remplir |
|---|---|
| Meilleur moment pour les soins | Avant 10 h. Après 16 h : soins allégés uniquement |
| Formule d'entrée qui apaise | « Bonjour, c'est [prénom], on va faire la toilette, d'accord ? » |
| Choix à proposer systématiquement | Commencer par le visage ou par les mains ; maintenant ou dans cinq minutes |
| Support qui fonctionne | Séquençage visuel + minuteur posé sur le lavabo |
| Appui sensoriel apaisant | Chanson connue ; serviette tiède sur les mains |
| Geste qu'elle aime faire seule | Se coiffe si on lui met le peigne en main |
| Ce qui déclenche un refus | Porte ouverte, plusieurs soignants, télévision allumée |
| En cas de refus | Ne pas insister : report court annoncé, retour à l'heure dite |
| Formule de clôture positive | Nommer un geste réussi + annoncer le café |
| À signaler immédiatement | Refus nouveau, douleur exprimée, changement d'état |
Le point décisif n'est pas la fiche elle-même mais son contenu : des consignes concrètes, formulées en verbes d'action. « Personne anxieuse » ne dit rien à un remplaçant ; « fermer la porte, une phrase courte, proposer un choix » est immédiatement applicable, y compris par quelqu'un qui découvre la personne.
Passer des outils à une vraie compétence d'équipe
Comprendre pourquoi un refus survient, savoir négocier sans forcer et respecter la personne : la formation « Refus de soins » outille chaque professionnel, avec une approche douce et éthique. 16 leçons, 100 % en ligne, accès illimité, à son rythme. Attestation de fin de formation.
Découvrir la formation — 90 €Arranging the environment to prevent refusal
A large part of refusals occurs before the first gesture, in the environment. A noisy, poorly lit, cluttered, or rushed place generates tension; a calm and readable place diffuses it. These arrangements are inexpensive and often produce an immediate effect, sometimes more pronounced than any verbal technique.
| Factor | What triggers refusal | What we implement |
|---|---|---|
| Noise | Television, alarms, overlapping voices | Turn off background noise during care; lower the voice; display the voice scale for the team |
| Light | Harsh or insufficient lighting, backlighting | Soft and sufficient light, enhanced contrasts, avoid dazzling the person |
| Storage | Visible materials that cause worry, cluttered room | Prepare materials in advance, out of sight; clear and organized space |
| Visual cues | Absence of temporal and spatial markers | Readable clock, calendar, care pictograms, personal photos |
| Privacy | Open door, passages, exposed body | Close, cover, announce each gesture, respect modesty |
| Rhythm | Haste, multiple caregivers at once | A reference professional when possible, a measured tempo, announced gestures |
A principle runs through this table: reduce what surprises and what pressures. The person who refuses often seeks to regain control over a moment that is moving too fast for them. Slowing down, announcing, and lightening the sound atmosphere cost little and change a lot. These arrangements benefit everyone, including professionals, by lowering the ambient stress level.
None of these arrangements concern the medical gesture itself. Pain management, treatment adaptation, issues of food texture, mobilization, or restraint fall exclusively under the prescription and evaluation by a healthcare professional. In case of distress, pain, or concerning signs, contact your country's emergency services without delay.
Free DYNSEO resources and how to use them here
DYNSEO provides several resources freely accessible, directly usable to prevent and diffuse refusal. The goal is not to collect them but to choose two or three, display or laminate them, and have the entire team adopt them. Here’s how to specifically connect them to the situations described above.
Emotion thermometer
To be displayed in the room or kept in the pocket of a blouse. It is used just before care to gauge emotional state and decide whether to proceed, lighten, or postpone. It is the opening tool for sheets No. 1 and No. 9.
Choice wheel
Ideal for sheet No. 2. Write down two to four genuinely acceptable options and present it at the moment refusal arises, to transform a blockage into a shared decision.
Facial expression decoder
Workshop support (sheet No. 4) to build a common emotional vocabulary, reused later during care. Also useful for the team to discuss observed states without misinterpreting them.
Conversation cards
To be placed on the breakfast table or taken out before care (sheet No. 5). They recreate connection and prevent care from being the only interaction, which changes the reception of the gesture.
Voice scale
To be displayed in the common room and in the care room (sheet No. 6). It regulates the sound level of both the person and the team, the first factor of ambiance to act upon.
These supports combine with tracking tools to objectify what works. Tracking each care — accepted, deferred, refused, and with which tool — allows for identifying effective levers for each person in meetings. The complete catalog of free tools is freely accessible, just like the cognitive tests, useful for better identifying the preserved abilities to rely on.
The role of digital technology: which app, for which exercise
Digital technology alone does not defuse a refusal, and a tablet does not replace the relationship or care. It provides two things that are difficult to obtain otherwise: a motivating, rewarding, and visibly failure-free activity support, and a regularity of stimulation that maintains the abilities on which previous activities rely. When used well, it becomes a pleasant time that softens the relationship around care.
| Application | Audience | Useful usage here |
|---|---|---|
| SCARLETT | Seniors, Alzheimer's disease, Parkinson's | Short and rewarding sessions in residence; simplified interface; support for a positive time before or after care |
| CLINT | Adults, mental health, Stroke | Individual sessions of about fifteen minutes, adjusted to the level, to restore confidence and pleasure |
| MY DICTIONARY | Autism, aphasia, non-verbal communication | Daily exchange support, including during care, to express a need or refusal differently |
| COCO | Children aged 5 to 10 | Fun activities adapted to age, in a reassuring and never anxiety-inducing environment |
For an audience of seniors, in facilities as well as at home, SCARLETT is the app to prioritize: short sessions, systematic validation, and absence of abrupt failure make it a positive time that can precede or follow difficult care. A simple usage framework is necessary: one profile per person to keep the level just right, a fixed time slot rather than usage at the whim of availability, and a reference person who sets up and follows through. Without a reference person, a facility tablet ends up in a drawer within weeks. Count on about fifteen minutes a day: regularity is far more important than duration.
A well-thought-out use of digital technology indirectly affects the refusal of care. A person who has just experienced a rewarding time, where they succeeded and had fun, approaches the following care with less tension: one does not chain two constraints, one precedes the care with a positive moment. Conversely, the tablet should not become a power struggle: it should not be taken away as a punishment, and it should not be imposed when the person does not want it. Like other tools, it is offered, chosen, and adjusted to the preserved abilities. It is this coherence — between activities, the environment, supports, and digital technology — that makes the difference, much more than any tool taken in isolation.
The 5 mistakes that worsen refusal
- Insisting and arguing in the face of refusal. Repeating the instruction in a firmer tone increases tension. It is better to defer, offer a choice, or change the angle than to win a tug-of-war that will cost dearly in the next care.
- Improvising without support or reference. Without announcement, sequencing, or ritual, each care is a surprise — and surprise fuels opposition. Visual tools are not an addition: they are the framework.
- Letting everyone do it their way. If the level of expectation and the formulas vary from one professional to another, the person loses their bearings and refuses more. Team coherence matters more than individual talent.
- Ignoring the environment. Trying to convince in noise, haste, and harsh lighting deprives one of the simplest lever. One first acts on the decor, then on the relationship.
- Not writing anything down. What calms a person — their formula, object, schedule, trigger for refusal — is lost at the first replacement if it is not noted. A ten-line preference sheet is worth hours of re-explanation.
To go further
Concrete Situations10 difficult everyday situations and how to respond to them
Professional PosturePosture, teamwork, and skill development in the face of refusal
The TrainingProgram, content, and who the "Refusal of Care" training is aimed at
To equip yourself beyond this article, explore the catalog of free tools, the cognitive tests to better identify preserved abilities, and the application CLINT for an adult audience. The entire DYNSEO training complements this toolbox.
Frequently Asked Questions
How often should these activities be proposed?
Regularity is more important than intensity. It's better to have a short ritual every day than a large workshop once a week. The care preparation tools — thermometer, choice wheel, entry ritual — are used with every care, as their repetition establishes predictability and trust. Link or emotional regulation activities, such as conversation cards or expression decoders, benefit from being repeated several times a week at a stable time. The key is consistency: a tool used every other day, or by only one professional, loses most of its effect.
How long should each activity last?
Short, almost always. Most preparation tools take less than a minute: showing the thermometer, offering a choice, announcing the steps. Link or stimulation activities last between three and fifteen minutes depending on the person's fatigue level. The key to monitor is not the timer but the attention: stop before fatigue sets in, on a positive note, rather than stretching until disengagement. For digital activities, about fifteen minutes a day is more than sufficient. Exceeding the person's capacity produces exactly what we seek to avoid: tension and refusal.
How to maintain motivation, both for the person and the team?
On the person's side, the key is success: calibrate the activity so that it succeeds in the majority of trials, precisely name what worked, and conclude on a positive note. Public failure extinguishes motivation for the long term. On the team side, motivation comes from visible results: tracking accepted care using a specific tool makes progress concrete in meetings. Starting with one person and one tool facilitates buy-in: a small shared success convinces better than a speech. Finally, collective consistency prevents discouragement related to practice discrepancies from one professional to another.
What minimum equipment is needed to start without a budget?
Almost everything can be set up without expense. The entry ritual, two-step care, positive recap, or cooperative care require no materials, just shared practice. For visual supports, the free DYNSEO tools — emotion thermometer, choice wheel, voice scale, conversation cards, expression decoder — can be downloaded, printed, and laminated. A visual timer and a few pictograms complete the set at low cost. The real investment is not financial: it’s the time to harmonize practices within the team so that everyone uses the same references.
Are these tools suitable for all ages?
The principle — predictability, choice, emotional regulation, calming environment — applies at any age, but the supports are adapted. For a child, a protective tone, simple pictograms, and a short duration are prioritized, without ever making care anxiety-inducing; any sign of distress justifies consulting a doctor or psychologist. For an adult or senior, vocabulary and digital application are adjusted to the audience. In all cases, we start from the preserved abilities and preferences of the person. The important thing is to individualize: the same tool is adjusted differently according to each person's age, history, and situation.
These proposals are general professional guidelines for support. They do not replace the protocols of your organization, nor the individual assessment by a healthcare professional. A new or unusual refusal must be observed, recorded, and reported: it may reveal pain or a pathology. Diagnosis, prognosis, and any care decisions are the responsibility of the healthcare professional. In case of emergency, contact the emergency services in your country.
In the face of refusal of care, a equipped and calm team
Beyond the activities and tools presented here, the training “Refusal of care: understanding, negotiating, and respecting” conveys a gentle and ethical approach to each professional: understanding the origin of the refusal, negotiating without forcing, respecting the person. 16 lessons, 100% online, unlimited access, at your own pace. Certified organization Qualiopi (N° 11757351875), certificate of completion.
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