Enhancing patient motivation to change

VIEWPOINT

Should we consider non-compliance a medical error?
N Barber
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Qual Saf Health Care 2002;11:81–84

Non-compliance is an extensive intractable problem.
This paper argues that we can gain significant insight
into non-compliance if we apply theories developed to
explain human error in organisations. The resultant
framework encompasses intentional and unintentional
non-compliance, shifts blame from the patient, and
recognises the influence of other factors, including
organisational ones. There are also consequences for
the measurement of compliance and new strategies to
improve it. Terminology will need to be addressed,
particularly whether intentional non-compliance by a
patient should be considered an error. If empirical
research supports the arguments in this paper then, with
some further theory development, the application of
human error theory will offer a useful new approach to
understanding and reducing undesired non-compliance.
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A
round one third to one half of patients do not

take their medicines as directed, yet this is
not usually considered to be a medical

error. Should this be the case? This article
explores whether it should, and argues that there
are benefits in applying the literature on errors to
non-compliance.

Non-compliance is a substantial and, as yet,
intractable issue; any new insights into it are to be
welcomed. Estimates have remained constant
over the years, that 30–50% of patients on chronic
medication do not take their medicines as
directed.

1 2 We do not know the full consequences
of non-compliance on the population as a whole.
The economic studies have been limited, but all of
them suggest substantial consequences. In 1985
Smith estimated cardiovascular non-compliance
alone resulted in 125 000 deaths in the USA
annually and a further $1.5bn in lost earnings
from hospitalisations.

3 Another study suggested
non-compliance to just 10 drugs cost the USA
between $396 and $792 million each year,4 and
the overall cost to the USA of all non-compliance
is estimated at $100bn annually.5

The mutual exclusion of non-compliance and
errors is fairly comprehensive. I failed to find any
mention of non-compliance in a quick skim of my
books on error, so I searched Medline over the last
quarter century. Using the terms “patient compli-
ance OR medication errors” there were 24 702
references; searching for “patient compliance
AND medication errors” and restricting the
search to “English” and “journal article” reduced
the nu

Ann Russell Dernbach

DQ1

In the past few decades there has been a paradigm shift in healthcare from an authoritarian type of delivery, where the healthcare provider makes all the decisions and the patient is required to follow them, to a patient-centered style, where the provider and patient are partners and collaborate to make decisions. I believe this is important to point out when answering this question. Instead of ensuring compliance the nurse should strive to ensure adherence to the mutually agreed on plan. Adherence denotes collaboration, compliance insinuates a power relationship and leads to better patient outcomes (Flavo, 2010). 

Since medical nonadherence has many consequences, including monetary, health, psychosocial and even death, it is important that the nurses address any obvious or potential areas for nonadherence. The first step in developing a plan for Alma will be to assess the cognitive function of Alma and her knowledge base of the procedure and post-procedure needs. Asking simple direct questions will yield the answer necessary to formulate more specific open-ended questions. It should be discovered if Alma has access to resources and accommodations needed to be adherent to the plan. Next the nurse should develop a plan in collaboration with Alma. After the plan is collaboratively agreed upon the nurse should work with Alma to put the plan in place. Lastly, the nurse should ensure adherence by following-up with Alma to determine if she is following the mutually agreed upon plan. If Alma is nonadherent then the nurse will have to engage Alma to discover where the shortcoming is and together, they should reformulate the plan. 

In the case of Alma, it will be imperative that she feel a sense of respect is being given to her. I say this based upon the fact that she insisted that her name be pronounced correctly before she would partake in any part of treatment. It will be difficult to gain a level of trust with Alma since she already feels disrespected by the staff. To gain her trust the nurse should apologize and show clear collaboration throughout the entire encounter and after care. After trust established it should be discovered what accommodations she will need and how to incorporate them into her current lifestyle. For example, if she currently is adherent to her medication regimen it should be discovered why. Does someone set her pills out for her? Does she prefer to take her pills at a specific time of day? Will she need some sort of reminder to take her pills? The detrimental effects of medication nonadherence should be explained to Alma. And proper agreed upon interventions should be put in place so that negative effects do not happen (Barber, 2002). 

Reference

Barber, N. (2002). Should we consider non-compliance a medical error? Quality & Safety in Health Care, 11(1), 81. 

Maybelline Aguilar

DQ1

Patient compliance does not solely rely on the patient’s ability to follow medical advice/directions, but also includes a holistic approach to developing a plan of care based on patient-specific physical, mental, and cultural/spiritual needs (Rothenberg, 2003). Alma is awaiting to have an invasive procedure done and this can be a frightening process from the beginning of scheduling the appointment. I believe that Alma wants to trust the medical professionals that are going to perform the procedure, but how can she if they cannot pronounce her name correctly? This may be interpreted as impersonal service and she may believe that she is not going to receive the best care. 

I believe the first step in approaching Alma is to issue an apology for the mispronunciation of her name and the tone in which she was spoken to. Secondly, it is important to ask Alma for the correct pronunciation of her name and what she prefers to be addressed as from the medical staff. I believe these steps could potentially help build rapport between patient and medical staff. After establishing rapport, medical staff should identify patient strengths and barriers for adherence of plan of care. Identifying barriers such as social and educational factors, patient perceptions of healthcare system, and support systems are important in ensuring the patient’s needs can be met. 

Patient education is extremely important when providing medical care and ensuring adherence to plan of care. The approach I would take in this case is to first identify Alma’s learning needs. Assessing Alma’s knowledge on her current health condition and procedure is important. If further education is needed it is important to ask: What is her preferred learning style: written, visual, auditory, or hands-on? I would tailor educational resources suited to her needs. If able to, I would also provide education to family to ensure everyone is on the same page. Prior to the procedure, I would have Alma relay the information back and fill in what is missing. 

Reference

Rothenberg, G. M. (2003, June). How To Facilitate Better Patient Compliance. Retrieved February 9, 2022, from https://www.hmpgloballearningnetwork.com/site/podiatry/article/1612 

Katrin Lindsay

DQ1

Mrs. Faulkenberger would like to be addressed respectfully, with her full name. The healthcare professional assumed calling her by her first name is sufficient but it should be the other way around. It is best practice to start addressing the patient with the correct full name and if the patient offers to address her differently that can be done after. First, the relationship has to be build carefully to gain trust and rapport with the patient. In this scenario the trust will be harder to gain since the patient already had an unpleasant first impression of the health care professional.

A plan to turn the situati

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Makoya Suomie

Homework Topic One

Summary

 789 Words  

1

2

Compliance and Education

Define patient compliance and explain its importance in your field.

Compliance and Education

Student’s Name

Institutional Affiliation

Course Details

Instructor’s Name

Date

Patient compliance involves the extent to which the client’s behavior or conduct adheres
to the caregiver’s advice and subscribes to the caregiver’s authority. Patient compliance is

important in nursing as it improves patient outcomes, reduces health complications, and prevents

hospital re-admissions (Cortellini et al., 2019). Moreover, patient compliance reduces the cost of

care and mortality rates.

Identify the health care professionals’ role in compliance and give examples of ways in

which the health care professional may actually contribute to noncompliance.

The caregivers’ role in client compliance involves giving sufficient information to the

patient concerning the treatment plan. Moreover, the care practitioners are required to educate

the patient to improve their health literacy and boost compliance. Among the examples in which

care practitioners can encourage non-compliance include failing to provide the patient with

sufficient information about care, being rude to the patient, being disrespectful, communicating

poorly, and being culturally insensitive when handling the patient (Cortellini et al., 2019).

Compare compliance and collaboration.

Compliance means the level to which a patient observes and follows guidance from care

practitioners on care. In such a situation, compliance perceives healthcare professionals as the

authority the client is required to obey. Collaboration involves forming a good partnership

between clinicians and patients to achieve patient adherence to the healthcare plan. Collaboration

is working together with other stakeholders to improve patient outcomes.

3

Compare and contrast patient education in the past with that practiced today.

There is a significant difference between the present patient health education and that of

the past. In the past, the care practitioner was the authority. The patients were required to strictly

adhere to the health professional’s advice. During the present times, patient education is much

more collaborative, where the goal of a health professional is deve

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