First of all if it has been care planned and documented that this woman flat out refuses care, you shouldn't have been cited.
Second-when I was a brand new nurse on my first job in a SNF, the older nurses sent me down the hall to deal with the "Mean Cranky Rotten OLD woman' who lived in the last room. They told me she was mean and demented and would try to bite and hit anyone who tried to do mouth care. I went down to introduce myself....she didn't seem mean but was a bit demented. I looked in her chart and there it was....a diagnosis of Tic Doloreaux...it's an inflammation of one of the cranial nerves which can make even a puff of air feel like hot pokers going into your skin. I mentioned it to the charge nurse and she sarcastically said in a voice loud enough to be heard on the whole unit "Oh my aren't you smart for a new graduate."
So I explained what the disease was and she said no one had ever heard of it and again said 'You think you're so smart and you've only been a nurse a few days'
I might have been the tiniest bit fresh
when I replied "Yes I am
smart since I graduated at the top of my class and even a new grad would know to look something up if they didn't know what it was."
So my long winded point....investigate the source of the pain before writing the patient off as demented and non-compliant.