Alma Faulkenberger is an 85-year-old female outpatient sitting in the waiting room awaiting an invasive pelvic procedure. The health care professional who will assist in her procedure enters the room and calls “Alma
Write a short (50-100-word) paragraph response for each question. This assignment is to be submitted as a Microsoft Word document.
1. Define patient compliance and explain its importance in your field.
2. Identify the health care professionals’ role in compliance and give examples of ways in which the health care professional may actually contribute to noncompliance.
3. Compare compliance and collaboration.
4. Compare and contrast patient education in the past with that practiced today.
5. Explain the importance of professional commitment in developing patient education as a clinical skill.
6. Explain the three categories of learning and how they can be used in patient education.
7. List three problems that may arise in patient education and how they would be solved?
8. List some methods of documentation of patient education.
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.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 number to just 50. Most of these were studies
in which the authors simply regarded non-
compliance as an error but did not address it with
reference to any literature on errors. An exception
was the American Society of Hospital Pharma-
cists which did include non-compliance in its
guidelines on preventing medication errors in
hospitals.
6 Considering the development of the
literature on the causes of errors, the growing
application of human error theory in medicine,
and national initiatives to reduce errors in the UK
and USA, it seems a good time to reassess
whether the overlap should be so small.
NON-COMPLIANCE
To understand the reasons for the separation of
these two literatures, we need first to understand
the definitions and causes of non-compliance.
Compliance is usually defined as the extent to
which patients follow medical advice.7 While
often used with respect to medicine taking (as I
will use it in this article), it need not be so, and
could apply to the following of any advice on
health. This commonly used definition is based on
patient behaviour (an outcome based definition
also exists8), and is rather like saying someone
has a “stomach ache”—while it expresses a
condition, it is not clear how serious it is and there
may be many causes, each of which may require
different solutions. Non-compliance to medi-
cation is often set at some level—for example,
that less than 80% of doses are taken correctly.
While this definition is precise, if somewhat arbi-
trary, it is difficult to assess as it is hard to find the
true nature of patients’ behaviour.
The term “compliance” is itself controversial,
and this controversy is informative. In the 1970s it
was felt that doctors told patients the right thing
to do, and that patients should comply with these
directions. However, Stimson,
9 in a seminal paper,
argued that it was inappropriate to see patients as
“defaulters” and he put forward the patient’s side
of the argument. More recently the term “adher-
ence” has been suggested as being more suitable
than compliance, as it is seen to lack the implied
one sided value implications of “compliance”.
Adherence became more popular, particularly
with researchers, but it was never that familiar to
practitioners and so has been limited in its use.
More recently, with the growth of interest in
patients participating in decision making, the
objections to “compliance” are weakened (as it is
compliance with, ideally, an agreed regime), and
the term seems to be becoming popular again.
“Concordance” is another term which is some-
times used, inappropriately, as a synonym for
compliance. In a document entitled “From compli-
ance to concordance”10 a specific form of doctor-
patient interaction about medicines was sug-
gested, and it was inferred that this would
improve compliance. Perhaps because of the title
of the article, some people incorrectly assume
. . . . . . . . . . . . . . . . . . . . . . .
Correspondence to:
Professor N Barber, Centre
for Practice and Policy, The
School of Pharmacy,
29–39 Brunswick Square,
London WC1N 1AX, UK;
nick.barber@ulsop.ac.uk
Accepted for publication
10 January 2002
. . . . . . . . . . . . . . . . . . . . . . .
81
www.qualityhealthcare.com
concordance is a modern word for compliance. These
definitional arguments are not just academic semantics, but
have at their core the role of the patient’s free will, and
whether the exercising of free will can be considered an error.
This issue will be discussed later in this paper.
About 200 factors have been attributed to cause non-
compliance.
11 However, the causes—and hence the patients—
are usually split into two groups: intentional and uninten-
tional non-compliers. Those who intentionally do not comply
have made the decision consciously; the others wish to comply
but cannot do so for some reason. In reality there is some
overlap between these groups. For example, some patients
who forget to take their medicine (which would be classed as
unintentional non-compliance) will do so because their view
of the medicine, its importance and risks, may have made tak-
ing the medicine a low priority, and hence more easily driven
out of mind by other matters.
What do we know of patients’ intentions? The trend in
recent times has been for psychologists to focus on the causes
of intentional, rather than unintentional, non-compliance.
They have applied several theoretical models to explain
non-compliance
12—for example, social cognition models,
stage models, and Leventhal’s self-regulatory theory. These do
have several limitations and are not particularly good at
predicting actual behaviour. When models allow regression
modelling, in which the extent of compliance is the outcome
variable, they generally account for a relatively small
proportion of the observed variability. One reason for their
limited success may be that they apply a theory to all
non-compliers, whether intentional or unintentional. We
would expect these models to predict intentional non-
compliance much more than unintentional. Unless a substan-
tial proportion were intentionally non-compliant, we would
expect the noise from the others to weaken the explanatory
power of the model. Although the division of non-compliance
into intentional and unintentional is of long standing, I have
been unable to find any papers that report the proportion of
non-compliance in each group, so we still do not know how
well we would expect the models to work. This is obviously of
importance if we wish to reduce non-compliance. Different
causes will require different solutions. While these theoretical
approaches have helped our understanding of compliance, as
Horne and Weinman note,
12 the capacities of the models to
generate effective interventions have yet to be fully evaluated.
The intractability of non-compliance is another clue that a
new approach may be welcome. A Cochrane review13 found
that there had been few well conducted studies, and that
many interventions failed. Only one study of short term treat-
ment was effective and, of the 17 randomised controlled trials
of long term treatment that were of sufficient quality, only
nine led to improvements in treatment outcome. Nearly all the
successful studies used complex mixtures of interventions.
The current explanatory models of non-compliance are
limited and there is a lack of effective solutions; there is room
for a new approach. Having conducted research into
non-compliance and, separately, into human factors in medi-
cal error, I find the stories of non-compliant patients remind
me of the stories of those who have made errors. So far I have
been unable to find any application of human error theory to
non-compliance. In the next sections I describe current think-
ing on the causes of errors, illustrate how these explanatory
models and techniques could explain non-compliance, sug-
gest how the approaches could inform research, and outline
some difficulties with the approach.
MEDICAL ERROR THEORY
This analysis is based on Reason’s descriptions of the causes of
human error14 15 which are adapted to non-compliance in fig 1.
In Reason’s terms, unsafe human acts follow intended or
unintended actions (equivalent to intentional or uninten-
tional non-compliance). Unintentional actions are made up of
slips and lapses. These occur when people intend to do an
action but do not do it properly; they occur largely in the auto-
matic carrying out of routine tasks. Slips are a result of a lack
of attention—for example, inadvertently taking the wrong
tablet. Lapses result from failure of memory such as forgetting
to take a dose.
Mistakes are intended actions that are wrong, but are
carried out with the intention of doing the right thing, so the
perpetrator is unaware that what they are doing is wrong;
these would be classified as intentional non-compliance. They
occur once a problem has been recognised in the current plan.
There are two types of mistake—rule based and knowledge
based. Rule based mistakes, by far the more common, occur
when the person is operating to a set of rules, but the rule they
use is wrong; knowledge based mistakes are rarer, and occur in
novel situations when the person is faced with a problem and
has to work out what to do from their existing knowledge,
rather than knowing a rule that fits the situation. Rule
based
mistakes include misapplication of a good rule and application
of a bad rule. An example from non-compliance would be that
some patients on chronic medication become concerned about
addiction
16 and therefore deliberately stop taking a drug for a
period each year (sometimes called a “drug holiday”) even
though the drug is not addictive. Application of a bad rule can
occur in the case of inhaled steroids; I have met patients who,
having heard about the effects of steroid abuse in sport, fear all
steroids so choose not to take their medicine as frequently as
directed. Knowledge based failures would include a patient
Figure 1 Non-compliance illustrated
using Reason’s framework.
Not getting
prescription
dispensed
Violation Mistake Slip Lapse
Knowledge
based
Rule
based
Not getting
emergency
supply
Taking �drug
holiday� because
fear addiction
Taking wrong
tablet
Forgetting a
dose
Intended action
(intentional non-compliance)
Non-compliance
Unintended action
(unintentional non-compliance)
82 Barber
www.qualityhealthcare.com
who runs out of an important medicine (for some reason that
is not their fault) and is faced with a decision of what to do;
they may err by choosing to wait several days before seeing
their doctor rather than getting an emergency supply from a
pharmacy.
The final category of intentional acts/non-compliance is
that of violations; these are deliberate deviations from safe
practice. The boundary between violations and mistakes is
rather blurred, but a guide is obtained by considering whether
the error occurs solely from “internal processing”, in which
the person is trying to do the right thing but does not (a mis-
take), or whether the issue is more motivational and caused by
their operating in a wider social context (a violation). A delib-
erate violation would be choosing not to get a prescription
dispensed because the patient felt the doctor hadn’t listened
and so could not have understood the problem. Other
violations include taking “short cuts” that bend the rules to
make life easier, such as taking several medicines together
which should be taken at different times, or taking a
non-steroidal anti-inflammatory drug on an empty stomach.
Violations need not be bad and, indeed, can avoid harm.
Deliberate non-compliance can be the right thing for a patient
to do, such as not taking a diuretic before a long bus journey.
Following the categorisation of errors and violations,
Reason and others have gone on to consider the aetiology of
accidents in an organisation. Organisational processes and
management decisions create an environment that may
encourage errors; these failures are known as latent errors as
they create the background against which errors are more
likely to occur. Partly as a result of the latent failures, there are
also local conditions at the time of the accident which may
increase the likelihood of a worker making an error. While
much of this theory has been derived from studies of accidents
in areas such as nuclear power, aviation and shipping, it also
applies to health care. The patient, even though at home, has
engaged with and is part of—indeed, the end point of—a large
organisation with the goal of improving health. Human error
theory is not the only body of learning to address these areas.
Theories in psychology include attitude and “norms”;
sociology includes organisational and social issues; however,
error theories seem best to pull them all together.
The organisational model presents the people who make the
error as “the inheritors rather than the instigators” of an
accident.
15 Consequently, in health care there is a widening
from studying the person who made the error to also seeking
organisational and local factors that caused them to make the
error. There is the need for a similar shift in non-
compliance—we should shift the focus from the patient to
their local environment and the organisation of care support-
ing them. There are differences, of course. Contributing local
factors in a hospital, such as the shift system, being short
staffed that day, poor lighting etc, may have equivalents in the
patient’s home, work or life in general, but may well not be the
responsibility of the healthcare system. However, this ap-
proach can direct our attention to the causes of non-
compliance and to suggestions of ways in which the patient or
others could resolve them.
Examples of latent failures could be the doctor’s style of
communication with the patient
17 or the remuneration system
for pharmacists, which leads to many of them dispensing large
numbers of prescriptions at the cost of helping smaller num-
bers of patients become compliant (although there are
suggestions which would change this in the current NHS
plans for pharmacy18). Non-compliance resulting from the
system of information transfer on discharge of patients from
secondary to primary care is common.19 Local factors could be
related to where the patient kept their medicines or how they
decided to ask for repeat prescriptions (for example, the
length of time before their medicines ran out that they asked
for them), or the use of a carer to ensure the medicines were
given.
IMPLICATIONS FOR THEORY AND PRACTICE
One advantage of the recognition that organisational factors
can produce errors has been a shift away from blaming the
individual who made the error. This is not only fairer (in the
majority of cases), but also has the pragmatic benefit that it
encourages people to be open about errors and, if linked to a
monitoring mechanism, can lead to safer systems. A similar
benefit could accrue if we adopted the same mechanism for
non-compliant patients. I suspect little has changed since
Stimson observed that non-compliant patients were seen as
“deviants” by doctors.
9 We need a mechanism to remove this
stigma from patients and to encourage them to speak openly
about how they use their medicines. We need to capture the
information and learn from it.
This is reinforced by another area in which non-compliance
research can benefit from the study of errors—that of deciding
what we should measure and be concerned about. In studies
of non-compliance the term is usually defined as a patient
taking less than 80% of their doses as intended. This
proportion presumably derives from the knowledge that most
drugs follow a log dose response curve, so the reduction in
clinical effect would only be likely to be evident when the total
dose fell below about 80%. This suggests the term “non-
compliance” has been used to conflate two terms, one reflect-
ing incidence and the other severity. As with all such
measures, it provides a simple dichotomy but it raises the issue
of whether this dichotomy is helpful. I would suggest that it is
limited as it imposes a threshold before studying errors, and
its link to outcome is tenuous. In contrast, it has been recog-
nised in organisations that, while major errors are rare and
therefore hard to study, they are often unusual concatenations
of commoner minor errors. There is a direct relationship (often
drawn as a pyramid) that, for every case of an error causing
major harm (shown at the tip of the pyramid), there are pro-
portionately larger and larger numbers of incidents producing
less and less harm (shown in layers beneath the tip). One
study showed that, for every case of major harm, there were
seven injuries and 189 non-injury accidents.
20 The number of
harmful incidents can therefore be reduced be reducing the
number of minor errors.
What can this teach us about non-compliance? Firstly, that
all cases of non-compliance are of interest, whether one dose
or many, so the use of the 80% cut off is unhelpful. Minor
errors are easier to study and hence to understand their causes
and devise remedial solutions; by reducing their incidence it is
possible to reduce the incidence of major errors. This approach
would seem likely to bear fruit in studying non-compliance. If
all cases of missed and inappropriate doses are studied, we will
be likely to identify common causes including intentional,
unintentional, and latent organisational ones. No theoretical
explanation of non-compliance has been able to do this so far.
We can then devise better solutions that, by reducing the inci-
dence of minor “errors”, will also reduce the harm caused by
non-compliance.
Removal of the 80% threshold has another advantage. It
forces us to make explicit the relationship between non-
compliance and harm. Instead of just counting the incidence,
we should also be focusing on the effect it has on patient
health. Why do some cases lead to hospitalisation or death and
others do not? More empirical work is needed in this area.
One final implication of the influence of the organisational
model on non-compliance is that it affects the design and
interpretation of research. A study of several hundred patients
of one doctor is less likely to be useful than a study of fewer
patients from a greater number of doctors’ practices.
While I have been emphasising similarities between the
application of human error theory to errors in complex
organisations and a patient taking their medicines, there are
some significant differences. An organisation is trying to pro-
duce some end point in a safe manner, which it does by con-
trolling the systems and activities of its staff. If someone
Non-compliance 83
www.qualityhealthcare.com
delivering health care commits an error, it is usually somebody
else who suffers. A patient is different; they are both the actor
in a process and the end point of that process, and if they make
an error, it is usually they who suffer most. What is more, the
end point of that process is defined by the patient, or at least
influenced by them; it is the patient who first seeks treatment,
initiating the process which leads to them being directed to
take a medicine. If they choose to violate the dose directions,
then in the majority of cases it is their right—they chose to
start the process, so they can exercise their free will and with-
draw from it. The concept of error works best in a technical
rational system in which “right” is clearly defined on techni-
cal rather than moral grounds. Error is a much harder idea to
apply to patients taking medication where several conflicting
concepts of “good” might be at work. It would not be accept-
able to label a patient’s actions as an error if they were
exercising an informed judgement such as stopping treat-
ment. If we are to apply human error theory to non-
compliance, we will need to amend its terminology.
It is interesting that the dominant explanatory theory of
human error comes from psychology, and that psychology is
probably the dominant explanatory discipline in non-
compliance research. It seems likely that there could be some
fruitful merging within the discipline. For example, a patient’s
condition changes and their response to a medicine emerges,
particularly at the start of treatment when all is new. This
results in the patient going through a reflexive process of
reassessing their beliefs, and may result in them altering their
medicine taking behaviour. While this could be categorised as
a knowledge based mistake, it hardly seems to do justice to
such a complex evolving process. An alternative approach is
offered by some psychological models used in studying
non-compliance—for example, Leventhal’s self-regulatory
theory.
16 Work is needed to show whether these groups of
theories can, or should, be effectively spliced together.
CONCLUSIONS
Non-compliance is a substantial, expensive, intractable problem
in health care which can lead to misery and harm. I have argued
that the theories of the causes of human error in organisations
could provide a powerful explanatory model of non-compliance.
If my argument is supported by empirical research, then it
would lead to different approaches to reducing non-compliance
in practice, to conducting research into its causes, and to the
development of theory. Under this new paradigm, all deviations
from directions would be taken as informative causes of
non-compliance, and there would be the need to understand
the relationship between minor errors and harm. Errors and
non-compliance are supported by substantial literatures in the
field of psychology—it seems likely that there could be some
joint development of theory in this discipline. There is also a
need to develop the terminology. The combined issues of the
patient being the instigator of the process, the actor in the proc-
ess, the recipient of the consequences of the process, and an
autonomous individual (arguably, given their lack of infor-
mation) would all lead to the need to reconsider the terms we
use and their implicit values.
Human error theory has made significant advances over the
last decade. If we can re-configure it to non-compliance and
adapt it to remove terminology that may be a barrier to its
adoption, then this promises to be a significant advance in our
understanding and solution of non-compliance. To answer the
question posed in the title of this paper, we should not
consider non-compliance as a medical error as the terminol-
ogy is inappropriate. However, non-compliance has a substan-
tial amount to learn from medical error theory, and a merging
of the approaches could significantly benefit patients.
REFERENCES
1 Meichenbaum D, Turk DC. Facilitating treatment adherence: a
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2 Sackett DL, Snow JC. The magnitude of compliance and
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in health care. Baltimore, London: The John Hopkins University Press,
1979: 11–22.
3 Smith M. The cost of non-compliance and the capacity of improved
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4 Department of Health and Human Services. Prescription drug
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5 Lewis A. Non-compliance: a $100bn problem. Remington Report
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7 Haynes RB. Introduction. In: Haynes RB, Taylor WD, Sackett DL, eds.
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8 Gordis L. Methodologic issues in the measurement of patient
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9 Stimson GV. Obeying doctor’s orders: a view from the other side. Soc
Sci Med 1974;8:97–104.
10 Royal Pharmaceutical Society of Great Britian/Merck Sharpe and
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11 Haynes RB. Strategies for improving compliance: a methodological
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12 Horne R, Weinman J. Predicting treatment adherence: an overview of
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in medical conditions. Amsterdam: Harwood Academic Publishers,
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13 Haynes RB, Montague P, Oliver T, et al. Interventions for helpinmg
patients to follow prescriptions for medication (Cochrane Review). In: The
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available at http://www.update-software.com).
14 Reason JT. Human error. Cambridge: Cambridge University Press,
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15 Reason JT. Understanding adverse events: the human factor. In: Vincent
C, ed. Clinical risk management. Enhancing patient safety. London: BMJ
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16 Horne R. Representations of medication and treatment: advances in
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17 Barry CA, Stevenson FA, Britten N, et al. Giving voice to the lifeworld.
More humane, more effective medical care? A qualitative study of
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18 Department of Health. Pharmacy in the future: implementing the NHS
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19 Duggan C, Feldman R, Hough J, et al. Reducing adverse prescribing
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20 Health and Safety Executive. The costs of accidents at work. HS(G)96.
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Key messages
• Non-compliance is an extensive, intractable problem.
• Methods of studying human error in organisations may be
applicable to non-compliance.
• The consequences may be new insights into the causes of
and solutions to non-compliance.
• This paper is based on an argument; theory development
and empirical support are required next.
84 Barber
www.qualityhealthcare.com
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.
http://dx.doi.org/10.1136/qhc.11.1.81
Falvo, D. (2010). Effective patient education (4th ed.). Jones & Bartlett Learning.
DQ2
Ann Russell Dernbach
Interdisciplinary collaboration involves using a multifaceted approach to caring for the patient in a holistic manner. The interdisciplinary team (IDT) in health care generally incorporates a group of professionals such as nurses, providers, dieticians, respiratory therapists, occupational therapists, physical therapists and social workers or combination therein. The goal of the IDT is to provide care that encompasses a patient’s whole self, not just a diagnosis or specific need (Green & Johnson, 2015). When health care professionals collaborate on a patient case, they are more likely to provide more help through interventions than they would be able to achieve alone which results in enhanced quality patient outcomes.
As humans age the body goes through natural physiological changes which complicate care. Examples would be decrease visual acuity from common disease processes such as glaucoma and cataracts, muscle atrophy, decreased bone density, and slowed peristalsis to name a few. The IDT is needed to meet this population due the increased acuity of these patients. Not only can the health care IDT prove to be beneficial for quality care of the patient, external stakeholders, such as the Aging and Disability Resource Center (ADRC), serve as valuable community partners.
In the case of Alma, it would be imperative to conduct a thorough needs assessment to determine what resources she already uses, which resources would currently be beneficial, and what anticipated resources will be needed in the future. I would instill the help of the social worker from the IDT for referrals to community programs, such as meals on wheels. Also, the social worker could help place Alma in a physical therapy program should she need rehabilitation after the procedure. It will be important to evaluate the support system Alma has in place. Support such as local friends or families who aid in Alma’s care. No matter what collaboration takes place Alma should be the centric figure and any decisions should be mutually agreed upon by her and the stakeholders in her care. When patients feel engaged and in control they are likely to adhere to the plan of care.
Reference
Green, B. N., & Johnson, C. D. (2015). Interprofessional collaboration in research, education, and clinical practice: working together for a better future. The Journal of chiropractic education, 29(1), 1–10. https://doi.org/10.7899/JCE-14-36
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 situation around and have Mrs. Faulkenberger be compliant with her procedure and medication would be as followed: A thorough apology with a personal touch, explain why the mishap happened and share something with the patient that can help decompress the situation.
The next step would be to get to know the patient a little better such as assessing her feelings about being hospitalized, if she has a support system like family and friends and if she has any significant financial worries. We want to identify what motivates the patient and if the patients motivation comes from intrinsic or extrinsic nature. Extrinsic motivation comes from the outside like social encouragement, from friends and family for example (Cohen et al., 1997). It can help build trust and rapport and suggests things that the health care professional need to address rather sooner than later. Next would be to assess what the patient already knows about the procedure and her feelings about it. Is she stressed and anxious about it or does she fully understand why it is necessary and is looking forward to getting it done so she can have an improved life? It is imperative to identify if the patient understands and supports the idea of the procedure and if she doesn’t, she needs to be educated on this first. If she understands why the procedure is necessary it is more likely that she complies with the medication regimen. Mrs. Faulkenberger’s basic needs, need to be addressed and covered first before we educate on the procedure and medication. If the patient is worried about financial aspects for example, the education on the medication regimen will not be effective because she will not be able to afford the medication and other resources have to be provided. When we as health care professionals educate on resources, connecting with social worker etc. we ensure a greater chance of compliance with the medication regimen.
Cohen, S., Doyle, W., Skoner, D. P., Rabin, B. S., & Gwaltney, J.M. (1997). Social ties and susceptibility to the common cold. Journal of the American Medical Association, 277, 1940–1944.
Quinetta Petite
DQ2
How would you use collaboration to assist in compliance with a patient as difficult as Alma?
When we talk about patient compliance, I think there is a general misguided view of this concept. I know that when I first hear that a patient is noncompliant my immediate reaction is negative. However, something that I am working to change is this reaction. Noncompliance can be frustrating for nurses and other providers but ultimately when we see non-compliance this can be a good sign that a patient wants to be engaged with their healthcare in a more active and participatory way (Falvo, 2011). In Alma’s situation collaboration would be a valuable avenue for improving her compliance with the procedure and post-procedure recovery. This collaboration should occur between Alma, the physician overseeing/ performing the procedure, the nurse(s) assisting with her care, as well as any other members of the care team who will be involved in her care. Ideally, this collaboration would incorporate a lot of communication between the providers and Alma to better understand her medical history, her lifestyle behaviors, and her hesitations/ issues with the care being provided (Rothenberg, 2003). By collaborating directly with Alma the providers then have the opportunity to create a patient-based plan to engage Alma in her care. This can include education, asking the patient questions about her lifestyle and trying to adapt post-procedure recovery to her needs and preferences as is possible or other ways to empower Alma to be an active participant in her healthcare experience rather than feeling like she is just getting a procedure because she was told to get it.
References
Falvo, D. R. (2011). Effective patient education. Jones and Bartlett Publishers.
Rothenberg, G. M. (2003). How to facilitate better patient compliance. Podiatry Today. How would you use collaboration to assist in compliance with a patient as difficult as Alma?
ackie Engelsma
DQ2
A collaborative approach to healthcare involves using health care professionals from varying disciplines to coordinate care for a patient (Morgan, Bayly, Kosteniuk, & Elliot, 2019). This approach is focused on the patient, and is efficient, and cost-effective. The team-based approach uses individual roles and brings their expertise together, shares information and makes decisions together which result in the best care for a patient. This interdisciplinary approach shares the common goal of the best outcome possible for a patient.
Team collaboration could be useful with Alma to help her feel more comfortable and compliant with her procedure and treatment. The male staff member could communicate with the other health care members the importance of respecting Alma’s name, so the same mistake is not made again. He could also ask another team member, who is a female, to talk with Alma to determine her preferences. Through effective communication, and team collaboration to ensure everyone is working towards the same goals, Alma will develop a sense of trust and will become more compliant with her care. Open relationships between a health provider and a patient are a key factor in compliance (Falvo, 2010).
References
Falvo, D. (2010). Effective Patient Education. Retrieved from Jones and Bartlett Publishers: https://bibliu.com/app/#/view/books/9780763796181/epub/OPS/xhtml/frontmatter01.html#page_i
Morgan, D., Bayly, M., Kosteniuk, J., & Elliot, V. (2019). Collaborative approaches to team-based primary health care for individuals with dementia in Rural/Remote settings. Canadian Journal on Aging, 38(3), 367-383. doi:http://dx.doi.org/10.1017/S0714980818000727
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Makoya Suomie
Homework Topic One
Summary
789 Words
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Compliance and Education
Define patient compliance and explain its importance in your field.
Compliance and Education
Student’s Name
Institutional Affiliation
Course Details
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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.
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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 developing a therapeutic
relationship with the patients through closely having them involved (Wittink & Oosterhaven,
2018).
Explain the importance of professional commitment in developing patient education as a
clinical skill.
Professional commitment is crucial during the creation of a patient education intervention
because it helps in coming up with relevant client-centered educational content to deal with the
patient’s personal care needs. The education program needs to be particular to patients’ particular
care needs and match their educational levels and styles of learning (Yen et al., 2019). Moreover,
the education must be delivered so the patient can easily understand and implement educational
content. Developing a relevant and easy-to-understand educational program requires professional
commitment.
Explain the three categories of learning and how they can be used in patient education.
The three learning classes include affective, cognitive, and psychomotor categories
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(Wallace, 2019). The cognitive class of learning involves developing intellectual skills. During
patient education, the domain of cognitive learning is applied in facilitating the patient to
remember facts, including the process of self-care and taking medication. The affective category
is concerned with developing attitudes and feelings, including self-care and personal confidence
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beliefs. The psychomotor category deals with developing physical skills. The category improves
the patient’s capacity to take care of health needs, like physical exercises.
List three problems that may arise in patient education and how they would be solved?
Among the patient education, problems include functional impairments, language barriers,
and environmental barriers like noise. Language barriers can be solved through the use of
interpreters. Functional impairments like audio and visual impairments on the patient’s side can
be solved by using a suitable teaching approach like audio recording and large fonts.
Environmental problems like noise can be solved through conducting the educational sessions in
a comfortable and quiet environment, with appropriate lighting and ventilation.
List some methods of documentation of patient education.
Among the approaches of patient education, documentation is recorded audios, EHR
(electronic health records), and plans of teaching. Teaching plans shows the numerous
components of health education like the required resources, goals, and assessment methods to
establish the program’s effectiveness. EHR method of recording the health education entails
broad applications’ range to support care, like training.
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References
Cortellini, S., Favril, C., De Nutte, M., Teughels, W., & Quirynen, M. (2019). Patient
compliance as a risk factor for the outcome of implant treatment. Periodontology 2000,
81(1), 209-225.
Parekh, J. G., Sinha, R., & Parekh, S. (2020). Digital Media Effects in Eye Care: Overcoming
Language Barriers to Improve Patient Education and Compliance. Investigative
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Ophthalmology & Visual Science, 61(7), 3074-3074.
Wallace, D. (2019). Parts of the Whole: Logical Categories of Learning: Why Teaching QR is
Hard. Numeracy: Advancing Education in Quantitative Literacy, 12(2).
Wittink, H., & Oosterhaven, J. (2018). Patient education and health literacy. Musculoskeletal
Science and Practice, 38, 120-127.
Yen, P. H., & Leasure, A. R. (2019). Use and effectiveness of the teach-back method in patient
education and health outcomes. Federal practitioner, 36(6), 284.
