Advocating for Treatment of Noncompliant Patients

Noncompliance can be one of the most frustrating issues for a health professional to encounter because it undermines any efforts to help patients heal and improve their quality of life. Noncompliant patients risk their recovery when they neglect to follow treatment plans and can face serious medical consequences as a result. Because they spend the most time with their patients, it's important for nurses to understand the causes of non-compliance and know how to improve their chances of success.

What Causes Noncompliance?

It can be easy to dismiss noncompliant patients in your mind because it feels like your efforts are being wasted, but it may surprise you to learn that most patients don't mean to be noncompliant. In fact, it's often the result of not fully understanding treatment instructions or an external factor that limits their ability to comply.

"Often, there are reasons why patients are not doing what they should," states Gayle Byck, Ph.D., BCPA, CSA, and founder of InTune Health Advocates. "They may not understand or forget what the provider is telling them; they may not be able to afford the medications; they may not have transportation to get to follow up appointments; and they may not know what resources are available to help with costs, transportation, etc."

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What Steps Can You Take To Improve Compliance?

To provide the best quality of care for patients, nurses may sometimes need to seek out ways to save patients from themselves. By identifying possible reasons a patient may be non-compliant, you have the opportunity to address them and set them up for success.

Educate Patients On The Risks Of Noncompliance

Dr. Nikola Djordjevic, MD and Medical Advisor on LoudCloudHealth.com, suggests medical professionals "should make sure patients understand why it is important to comply with therapy and what will happen if they don't." Often, patients just need to be able to visualize a tangible consequence to motivate them to follow through with therapy instructions.

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Discuss Workable Solutions

There are many tools available to help patients who have issues with noncompliance. Depending on the patient, you will need to decide if a tech-based option is best or something more old-school. "It's hard to keep tabs on patients after they get sent home, especially when it's extra important for them to stay compliant to their treatment and medications," says Simon Greenberg, Patient Safety Consultant. "That's why I often recommend a medication adherence app such as MedManage which they can download for free to use at home. Since it reminds patients when it's time to take their medications and has all their relevant prescription info available to access on their phone, I feel patients are more prepared to get discharged if they are actively using such tools."

Build Confidence With Motivational Interviewing

One of the most common reasons behind noncompliance is a lack of motivation. Some patients may feel treatment instructions are too complicated or that they aren't strong enough to handle the discomfort. "Motivational interviewing can be an effective approach for getting to the heart of self-defeating behavior," says Ruth Linden, Ph.D., and founder of Tree of Life Health Advocates. "It does not provide a quick fix, but long-term change never does. It requires an investment of time on both the clinician's and client's part." She offers the following as the five principles of motivational interviewing:

• Express and show empathy toward clients
• Support and develop the discrepancy between the client's current behavior and their values and goals
• Deal with resistance(s)
• Support client's self-efficacy
• Foster client's autonomy

Work With Their Limitations

Sometimes noncompliance is completely unintentional but out of the hands of your patient. "Find out why they are being non-compliant," suggests Shantay Carter, BSN, RN. "Is it a lack of resources or what's their educational level? Sometimes we have to learn to meet people where they are. Find out their family dynamics and who is in their support system. Figure out a way to connect with them." Identifying likely compliance barriers, such as limited income or mobility issues, gives nurses the opportunity to seek treatment modifications that may be more accessible.

Noncompliance can be extremely detrimental to your patients, but there are steps you can take to increase your patients' chances for a successful recovery once they are discharged.

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