How to Improve Efforts from Noncompliant Patients

In a 2016 article published in The Journal of the American Osteopathic Association, William Scarlett and Steve Young refer to patient noncompliance as an "ever-expanding epidemic" that can wreak havoc with patient outcomes and make healthcare even more expensive. As a travel nurse, you have more opportunities to interact with patients than most medical professionals, giving you an important role in fighting this epidemic. Read on to find out what you can do to improve efforts from noncompliant patients.

Provide Encouragement

The first step to improving patient compliance is to recognize the obstacles patients face in accessing healthcare and paying for medications, physical therapy and other prescribed treatments. For some patients, something as simple as arranging transportation to a medical appointment is a major challenge. Instead of judging patients for their noncompliance, provide as much encouragement as possible.

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Dr. Nikola Djordjevic of MedAlertHelp says, "While doing this, medical staff should stay calm, understanding and supportive. There are many reasons someone's not following the instructions of the medical staff. It's on the medical personnel to listen and encourage and, before treating their physical problems, understand their psychological motivations and struggles." As a travel nurse, you have the opportunity to provide this encouragement in a variety of settings, from a patient's hospital room to the exam room of a private medical clinic.

Take Time to Gain The Patient's Trust

In an article reporting the results of their study on patient trust and its relationship to quality care, Thom et al. describe trust as "a fundamentally important aspect of medical treatment relationships." For some noncompliant patients, a lack of trust in the medical profession is what causes noncompliance, not difficulty understanding instructions or an inability to pay for medical care.

Jenna Kantor, PT, DPT, has several tips to help nurses and other medical professionals gain the trust of their patients. Kantor, who owns a private physical therapy practice in New York, recommends the following:

• The first time you meet a patient, do not talk for the first 10 minutes. Instead, allow the patient to speak without interruption. Kantor explains, "From simply listening to them, you will gain their trust."
• Each time you see the patient, make an effort to do more listening than talking. "The more you listen, the more trust you will gain, which will lead to them believing and heeding the advice you provide," states Kantor.

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Be Honest and Direct

Dr. Brooke Goldner, a psychiatrist and the author of Goodbye Lupus, has extensive experience working with difficult patients. She recommends talking to noncompliant patients in an "earnest and compassionate way." Goldner says, "I think the most important thing to understand is that a patient is not noncompliant because they wish to be oppositional or difficult. They are literally showing up in your office because they want your help. So, if someone is coming to you for help and they aren't listening to your advice...sit down and ask them why."

In many cases, patient noncompliance occurs because patients don't understand their diagnoses, their medicines or the instructions they were given. To improve compliance, do the following with each of your patients:

• Take time to explain the patient's disease.
• Provide detailed information on the treatments available; be sure to discuss the impact of not taking any medications, which Goldner notes is a "valid choice."
• Explain the patient's lab results without using medical jargon.

Change the way you think

Although patient compliance is a problem with serious consequences, changing the way you think about your patient's behavior can go a long way toward building trust and improving health outcomes. Gayle Byck, a Board-Certified Patient Advocate (BCPA) and Certified Senior Advisor (CSA), says that "noncompliant" is "often not the right way to think about these patients." She explains, "I believe that patients are rarely truly noncompliant; rather, they need someone who can help them better understand what they need to do and why, as well as identify and address social and financial barriers to following the treatment plan."

As a travel nurse, you have many opportunities to reframe the way you think about noncompliance. Instead of asking why the patient isn't complying with treatment recommendations, ask if there's anything preventing them from taking their medications, going to physical therapy or getting much-needed health screenings. If necessary, refer noncompliant patients to social workers or patient advocates for help overcoming these obstacles, recommends Byck, the founder of InTune Health Advocates.

If you frequently work with noncompliant patients, you have a unique opportunity to improve health outcomes by providing encouragement, taking time to gain the patient's trust, having direct conversations and reframing the way you think about compliance.

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