Diagnostic Tool of Non-Compliance Syndrome - Essay Example

Noncompliance Non-compliance poses a great challenge in healthcare management. It is common in patients with chronic diseases, requiring long-term medical interventions. noncompliant patients hinder appropriate and successful delivery of treatment for their own health. The diagnosis of non-compliance is by a set of a structured questionnaire with the intention of understanding the patient’s perception of the diagnosis, treatment and management of his or her own condition. There are guaranteed positive outcomes when appropriate interventions are put in place. Some of the outcomes include; full compliance or adherence to treatment and change in life that promotes good health depending on the treatment recommendations. Non-compliance is a complex problem that can affect and is also affected by economic status, change in lifestyle, and group approach interventions among other factors. Nursing interventions are successful and can yield tangible outcomes. However, effective interventions require identification and counteraction of factors that lead to non-compliance. Telling examples of these factors are unsatisfactory discharge instructions, economic difficulties, a language barrier, and cultural believes. Proactive attitude by nursing staff to counteract these factors yields desirable outcomes. Noncompliance Introduction and presentation of syndrome Noncompliance is the opposite of compliance (the degree to which patients follow medical advice) plagues patients with a diagnosis such as diabetes, renal failure, and hypertension (Fischer, Stedman, Lii, Vogeli, & Shrank, et al, 2010). Noncompliant patients inhibit appropriate treatment of their general health care and thus pose a medical hazard at a wide scale (Fischer, et al, 2010). Noncompliance does not imply to therapeutic medications, but also general medical advice such as self-supervised physical exercises and therapy sessions. Dealing with noncompliant patients is a challenge that nurses face on a daily basis while carrying out their duties. However, addressing these challenges proactively (by the nurse) can bring about positive outcomes among affected patients. This capstone project covers the approaches of identifying and dealing with noncompliant patterns in patients affected by various health issues on a nursing perspective. Diagnostic Tool Emerging literature on this subject suggests an increasing interest by researchers to delineate the problem. Noncompliant patients are difficult to research owing to their negative attitude towards healthcare givers (who are also the researchers). Consequently, this area is still gray and only limited literature exists. Noncompliance affects the wellbeing of the patients and, therefore, requires criteria to differentiate it from full or partial compliance. Table 1 below is a simplified diagnostic tool for noncompliance. This questionnaire is to be filled by a nurse or any other healthcare giver diagnosing the patient. Table 1: Showing a simple diagnostic questionnaire for noncompliance Problem YES NO Does the patient seem to be surprised or shocked by either the diagnosis or the doctors recommendations for treatment? Does the patient appear to doubt the diagnosis? Does the patient seem to doubt that the planned treatment will be helpful? Does the patient ignore, fail to cooperate, or actively resist the doctors prescribed treatments (including medication and life style change)? Does the patients condition show that he/she did not do whatever the doctor recommended - did not take the medicine, did not make the life style change, did not show up for therapies? Instructions: Please mark YES or NO to the following questions. Interpretation: “Yes” replies to four out of the five questions reveal positive diagnosis There are about three different response patterns related to the medical diagnosis in noncompliant patients they include, noncompliance, ineffective coping related to change of lifestyle, and helplessness. However, the response pattern chosen for this project is noncompliance. Noncompliance issue remains the center of this project because it offers less than desirable response from patients. This problem is multifaceted and correlated with patients’ state of mind regarding their current situation. In such cases, patients may exhibit shock, denial, ignoring helpful suggestions, and even uncooperative behavior towards the staff. These four behavior patterns have a direct negative impact on the patient’s compliance to medical advice. Desired and Realistic Treatment Outcomes. Desirable interventions are planned and put in place to assist patients in responding adequately to the less-than-desirable response. These interventions will lead to optimal outcomes by the patients. Given the proper interventions on time, the following outcomes are anticipated; Through counseling patients who doubting the diagnosis of a certain disease should come to terms with their medical diagnosis. Another outcome is on patients who are undergoing medicinal or other therapies increasing their adherence to medication. Following interventions, patients on conditional therapies should be motivated to practice proper nutritional protocol. A telling example is patients on diabetic treatment. Positively motivated patients should also effectively work and cooperate with nurses while under their care. These outcomes will aid patients in obtaining proper lifestyles and coming to terms with the need to be compliant. Review of Literature Life style adaptation Life style adaptation is a common challenge faced by patients under restricted or controlled medical interventions. For instance, diabetic patients may be required to control and monitor their diet in order to regulate their blood sugar levels. To understand challenges of lifestyle adaptation to noncompliance, two studies were reviewed. The first study by Curtis (2009) examined the ethical and medical concerns in kidney retransplantation of non-compliant patients. The second study by Hertogh, Schuit, Peeters, and Monninkhof, (2010) investigated the effect of sex hormone levels in women at risk of breast cancer. The two studies represent an excellent non-compliant or non- adherence syndrome cases, which are in line with the aims of this project. Both studies highlight the difficulty of researching non-compliant patients especially those with chronic conditions (Curtis, 2009). Moreover, they both express concerns about miss-labeling patients as non-compliant due to biases during diagnosis (Hertogh, Schuit, Peeters, & Monninkhof, 2010). Likewise, both articles show evidence that patients who do not follow the advice from healthcare personnel (non-compliant) end up with poor health outcomes. The first study represents cases of male and female kidney patients who need re-transplantation. In these cases, the female patient becomes non-compliant after her husband’s death, even though, her first transplantation many years ago had been successful because of her compliance (Hertogh, Schuit, Peeters, & Monninkhof, 2010). The male patient on the contrary is a typical non-compliant who left the hospital against medical advice with in Foley Catheter still in place (AMA) (Hertogh, Schuit, Peeters, & Monninkhof, 2010). The patient is readmitted a week later with his Foley catheter still in place but in a worse medical condition (Hertogh, Schuit, Peeters, & Monninkhof, 2010). The second study, on the other hand, provides evidence on causal-effect correlation between physical exercise and sex hormones in relation to female patients at risk for breast cancer. The difference noted between these two articles is within the population dynamics of the study cohorts. The cohort in the study by Curtis (2009) are patients with a history of chronic diseases while the second study by Hertogh, Schuit, Peeters, and Monninkhof, 2010) is a cohort based on risk of female post-menopausal diseases in relation to physical exercise and sex hormones. Discharge teaching/planning Non-compliance is a multifaceted problem and both the patient and the nurses contribute. Poor discharge teaching and planning protocols may directly contribute towards noncompliance, in susceptible patients. Investigate the effect two articles were reviewed to provide additional insight. The first study by Frank-Bander, Beltran, and Dojlidko (2011) examined the impacted of a comprehensive interdisciplinary patient education program on post-transplant patients. Similarly, Jeungok (2013) studied the effectiveness of pictograph-based approach in improving communication during discharge. The articles emphasize for discharge planning that begins upon admission and continuing until the patient is discharged from hospital (Frank-Bander, Beltran, & Dojlidko 2011). These studies recommend approaches that promote patients participation and cooperation so there can be an effective plan in place for positive patient outcome. The first article describes the use of a survey as a structured teaching approach to educate transplant patients upon discharge. It further encourages patient assessment to identify learning barriers and also involve all team members during the discharging process (Frank-Bander, Beltran, & Dojlidko 2011). The process needs to be planned and with systematic steps that enhance understanding by the patient. For instance if the patient is unable to read or write, then written material cannot be given to him or her. Conversely, the other article focuses on literacy level, as a major reason for non-compliance. Moreover, Jeungok, (2013), emphasizes on the importance of rehabilitating patients of low literacy and competence with pictures and illustrations. Economic Non-compliance as a healthcare problem also carries with it an economic burden. The economic impact of non-compliance may be felt at an individual level, community as well as the whole nation. Non-compliance and economic impact is a two-way scenario, where the two can negatively influence each other. Von-Boven, Chavannes, Van, Rutten-van, Postma, and et al. (2014) in his study investigates the economic impact of non-compliance in patients diagnosed with chronic Obstructive pulmonary disease (COPD) (Von-Boven et al, 2014). In another study included in this review, Hiligsmanna, Rabenda, Bruyère, and Reginster, (2010) investigates the same impact in non-compliant patients aged between 55 to 85 with osteoporosis. These two studies clearly show data about the negative outcomes of two various groups of patients with osteoporosis and chronic obstructive pulmonary disease (Von-Boven et al, 2014). The first study is based on a group of post-menopausal women with osteoporosis, who also showed non-compliance to the medication regimen due to economic challenges. The study further highlights that educating patients and positive cooperation of physicians improves patient’s compliance. Lack of motivation on patients’ perspective is a significant player, closely associated with the cost of medication in promoting non-compliance (Von-Boven et al, 2014). On the other hand, the COPD group had two groups of COPD patients, one in the emergency room (hospitalized) and the other non-hospitalized (Von-Boven et al, 2014). Improvement in desirable health outcomes is reported in the hospitalized patients with undesirable effects seen in the non-hospitalized group. Accordingly, Von-Boven et al, (2014), concludes that patients on continued medication have positive health outcomes. It is hypothesized that when patients are offered cost effective medications, then adherence to medication regimen is also improved. Group Approach The increasing level of non-compliance poses a national health risk as well as a negative impact on the economy. Consequently, group approach is a potential and effective strategy to enhance compliance awareness across the public. To investigate the effectiveness of this approach, Sharma, Kaur, and Sodhi (2012), assessed the baseline public awareness of H1N1 in India following a government awareness campaign. The study was conducted when the outbreak of the H1N1 virus became a global concern. According to this study, the behavior of patients affected was positive among those who were literate in New Delhi (Sharma, Kaur, & Sodhi, 2012). Once patients understood the ramifications of the disease, they were more cooperative and adhered to medical advice including isolation measures (Sharma, Kaur, & Sodhi, 2012). During the outbreak World Health Organization (WHO), termed it a pandemic that created a high risk for contamination and, therefore, non-pharmaceutical defense was used to eradicate the deadly flu (Sharma, Kaur, & Sodhi, 2012). However, about 35% of those who participated on the survey claimed having benefited from the state campaign (Sharma, Kaur, & Sodhi, 2012). The other study explored the effectiveness of community-based interventions to increase adherence to patients with chronic diseases (Van Dalem, Krass, & Aslani 2012). This study reported an improvement in adherence, in patients with cardiovascular diseases when they received behavioral interventions. According Van Dalem, Krass, and Aslani (2012), counseling by health care professionals also improved significantly the adherence of the patients. These two studies suggest that focused group interventions are more effective than campaigns targeting the general public (Van Dalem, Krass, and Aslani 2012). This difference may be attributed to by the level of participation of patients in both approaches. Recommended Nursing Approach Desired Goals/Outcomes The desired goal and outcome in nursing approach is for the patient to follow medication regiment prescribed by a physician. The overall outcome to the patient is improved health status and attainment of good health. When patients become complaint the resources will be managed appropriately and reduce the overall healthcare cost both at individual and societal level. There are, however, several hurdles that must be overcome before these goals are realized. For patients on dietary restrictions, it is beneficial if nurses can convince patients to avoid restricted certain foods as per the treatment protocol. However, this can be challenging considering certain foods in the diet are influenced by cultural believes. Stressors that Interfere with Goal Attainment Patient may become non-compliant due to quite a number of stressors they face and they are not in a position to overcome them. For instance, patients who are to be discharged may be given unsatisfactory discharge instructions that will hinder full compliance to treatment. Such challenges may be blamed at the caregiver and not the patient. Some patients may also become non-compliant due to financial difficulties that may hinder them from accessing proper medication. Such patients end up being full non-compliant. All medical treatments and interventions are founded on proper knowledge of the disease processes. Likewise, patients who have adequate knowledge tend to be more compliant than individuals who lack this experience. Lastly, patients may become non-compliant due to communication difficulties or language barrier. A cultural habit formed by the patient concerning certain treatment or medical interventions is a stressor in some people. Peer influence also plays a significant role in promoting non-compliance. Peers can be family friends and close relatives with a strong impact on the subject. Therapeutic Nursing Actions to Diminish Stressors In provide positive interventions, nurses need working approaches to identify and diminish stressors that may be faced by the patients. The following are some of the recommended approaches to nursing interventions. Nurses are encouraged to give discharge instructions to patients on lay terms regardless of their level of literacy. Nurses can also help build the knowledge base of the patient about the disease by giving suitable information to the patient on how the disease affects the body systems. Another strategy is to employ a qualified interpreter to overcome language barrier challenges. Therapeutic Nursing Actions to Fortify Defenses These approaches are not guaranteed success and sometimes resistance may be faced. It may be advisable for nurses to give the patients helpful resources that will help enrich their knowledge. These resources may be brochures or illustrated leaflets among other materials. Support groups are also effective in helping the patient accept their health diagnosis and treatment recommendations. The role of a nurse, therefore, would be in helping the patient locate supports of patients with related diagnoses. In conclusion, non-compliance is increasingly becoming a challenge in healthcare management. Non-compliance is a multi-factored problem that requires abroad and far reaching interventions. Non-compliance has undesirable effects on the economy at both individual and state level. Noncompliance is influenced by a number of factors such as, economic hardships, non-preferred changes in life style, and ineffective approaches to interventions among others. Nurses are daily affected by this challenge as they go about their duties in the hospital. There are a number of recommended interventions that can yield desirable outcomes such as full compliance and improved patient physician cooperation. Some of the recommended interventions include identification and overcoming language barriers and giving useful information about the disease. References Curtis, J. J. (2009). Nonadherence. American Journal of Transplantation. 9(6) 1261-1262. DOI: 10.1111/j.1600-6143.2009.02665.x Fischer, M., A., Stedman, M., R., Lii, J., Vogeli, C., Shrank, W., H., et al. (2010). Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions. J Gen Intern Med 25(4):284–90. DOI: 10.1007/s11606-010-1253-9 Frank-Bader, M., Beltran, K., & Dojlidko, D. (2011). Improving transplant discharge education using a structured teaching approach. Progress in Transplantation. 21(4), 332-9. Hertogh, E. M., Schuit, A., J., Peeters, P., H., M., & Monninkhof, E. M. (2010). Noncompliance in lifestyle intervention studies: The instrumental variable method provides insight into the bias. Journal of Clinical Epidemiology, 63(8), 900-6. DOI:http://dx.doi.org/10.1016/j.jclinepi.2009.10.007 Hiligsmann, M., Rabenda, V., Bruyère, O., & Reginster, J. (2010). The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients. Health Policy. 96(2), 170–177. DOI: http://dx.doi.org/10.1016/j.healthpol.2010.01.014 Jeungok, C. (2013). Improving discharge education using pictographs. Rehabilitation Nursing, 38(5), 240-246. DOI: 10.1002/rnj.101 Sharma, R., Kaur, S., & Sodhi, A. (2012). Knowledge, behaviour change, and anticipated compliance regarding non-pharmaceutical interventions during pandemic of influenza A H1N1 in delhi. Lung India. 29(4), 341-346. DOI:http://dx.doi.org/10.4103/0970-2113.102817 Van Boven, J., F., M., Chavannes, N., H., Van, d., M., Rutten-van, M, M., Postma, M. J., & et al. (2014). Clinical and economic impact of non-adherence in COPD: A systematic review. Respiratory Medicine. 108(1), 103-13. DOI:http://dx.doi.org/10.1016/j.rmed.2013.08.044 Van Dalem, J., Krass, I., & Aslani, P. (2012). Interventions promoting adherence to cardiovascular medicines. International Journal of Clinical Pharmacy. 34(2), 295-311. DOI:http://dx.doi.org/10.1007/s11096-012-9607-5 Read More