Nursing Care Plan: Non-Compliance with treatment regimen related to low socio-economic status, difficulty in understanding the disease.

Scientific Basis:

Adherence is the extent to which an individual’s behavior taking medications, following diets, or making lifestyle changes coincides with medical or health advice. Degree of adherence may range from disregarding every aspect of the recommendations to following the total therapeutic plan.

Factors influencing the compliance of the patient are motivation to become well, degree of lifestyle change necessary, perceived severity of the health care problem, value place on reducing the threat of illness, difficulty in understanding and performing specific behaviors, degree of inconvenience of the illness itself or of the regimens, beliefs that the prescribed therapy or regimen will or will not help, specific cultural heritage that may make adherence difficulty, degree of satisfaction and quality type of relationship with the health care provider and overall cost of prescribed therapy.

Preventing illness may not have as high priority among as generating and maintaining the income, even when prevention is priority. The poor may not have be able to afford regular medical examination, housing or nutritious food that promotes health. It is important to them to work than to lose a day’s pay visiting the physician. Reliance on public assistance and inability to afford health care insurance limit both low income person’s access to health care and the type of care available.

Berman, et al, 2002

Intervention and Rationale
I Assess client reason for non-compliance, health beliefs and cultural influence.
R: Listening to client’s reason may identify concerns and help to establish a plan of care.

I: Determine family’s knowledge of illness and treatment. Taught them the illness and purpose of the treatment regimen.
R: Compliance is increased by knowledge to the therapeutic regimen.

I: Assess the possible contributing factors leading to non-compliance.
R: A client who is noncompliant is expressing a need; the behavior has meaning and helps patient meet their needs.

I: Assess financial resources and refer to social services as necessary.
R: Inability to afford health care is a major contributing factor in noncompliance.

I: Avoid using threats, pressure and inappropriate fear of arousal to increase compliance.
R: These measures are unethical and generally ineffective.

I: Develop a therapeutic relationship based on active listening.
R: Compliance is increased when the family feels that the health care provider is interested in genuinely cares how the family is doing.

I: Consult with primary practitioner regarding the possibility of exemplifying the health care regimen so that it is more easily fits into client’s lifestyle.
R: The more the complex the regimen, the less likely they will follow it.

I: Encourage significant and family to follow treatment regimen as much as possible despite financial constraints.
R: For effectiveness of pharmacological treatment and use for good of the patient.

I: Discuss non-compliance with instruction and programs with SO.
R: To determine rationale for assistance.

I: Provide accurate information about the treatment regimen: present clear understanding of the drugs positive effect, explain how the medication works and why it helps, etc. at the patient’s ability.
R: Individuals who perceive a relationship between their actions and outcomes want a great deal of information about their illness and treatment in order to control the disease. Other who do not necessary rely on internal cues will comply more with the prescribed regimen when the information is presented accurately by a professional they believe to be an authority.

I: Make a compliance contract with client review it periodically.
R: Often clients will be more compliant initially but as time lapses and the condition becomes chronic, compliance tends to decrease.

I: Note length of illness.
R: Clients tend to become passive and dependent in long-term, debilitating illnesses.

I: Be aware of nurse/ healthcare provider’s attitudes and behaviors toward the client.
R: Some care providers may be enabling client whereas others’ judgmental attitudes any impede treatment progress.

I: Develop therapeutic nurse-client relationship.
R: Promotes trust, provides atmosphere in which client and significant other(s) can freely express views and concerns.

I: Explore client’s involvement in or lack of mutual goal setting.
R: Patient will be more likely to follow through on goals he/she participated in developing.

I: Review treatment strategies. Identify which interventions in the plan of care are most important in meeting therapeutic goals and which are least amenable to compliance.
R: Sets priorities and encourages problem solving areas of conflict.

I: Provide for continuity of care in and out of the hospital/ care setting, including long-range-plans.
R: Supports trust and facilitates progress toward goals.

I: Have client paraphrase instructions/ information heard.
R: Helps validate client’s understanding and reveals misconceptions.

I: Accept the client’s choice/ point of view, even if it appears to be self-destructive. Avoid confrontation regarding beliefs.
R: To maintain open communication.

I: Establish graduate goals or modified regimen as necessary e.g. patient to stop smoking cigarette.
R: May improve quality of life, encouraging progression to more advanced goals.

I: Develop a system for self-monitoring. Share data pertinent to client’s condition e.g. laboratory results blood pressure.
R: Provide sense of control and enables client to follow own progress and to assist with making choices.

I: May use of social workers, government welfare agencies, government officials and resources to assist the family in their financial problem.
R: They can provide support and assist in financial arrangement by allocating amount from government and other charitable agencies.

Doenges, et al, 2006; Gulanick, 2007; Kruse, et al. 2003

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