The Dirtiest Word in Chronic Health Care - page 2

by rn/writer Guide | 11,032 Views | 48 Comments

The Dirtiest Word in Chronic Health Care Our treatment of patients with chronic health conditions often looks more like a wrestling match than a collaboration. But what are we supposed to do with cardiac and renal patients... Read More


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    OK...I see your points. We don't want to come off in a demeaning or patriarchal way towards our clients/patients. Also nurses acutely recognize that life-style changes are never easy. But, can you please tell me what you call it when a client/patient does not do what is at least minimally necessary for their well-being? If that behavior is not to be described as "non-compliant", what other word-smithing shall we use? It seems to me that politically correct wording doesn't help anyone get better.
    I agree that nurses should strive to try any angle of teaching that will successfully escort clients/patients to wellness. But when all else fails, what do you call it..... Failure to Effectively Motivate?
    Nurse& likes this.
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    hi everyone

    not true , no nurse or dr or any health care provider takes away pts freedom of choice when asking or providing care that require specific actions for better or improved health. dr 's orders or prescription meds as we all know from what we learned in nursing/ medical school are provided to help cure/treat / improve or manage disease allowing pt or the ill to reach their optimal heath
    so i see nothing wrong with using "non-compliant " or "compliant" these are terms chosen to help communicate among care provider . would it make a difference if a different term was used instead?
    i understand that at time the provider may jump to quick conclusion labeling of "non-compliant" a pt who wakes up on a random day and don't feel like taking her/his morning pill ,but come on ....are all of these post advocating that we shouldn't make mention in charting as "non compliant "or "compliant " even when it is clear to be the case ??????? the original post in my opinion is a prime example of overthinking on a clear and simple subject of pt care . let face it !!!! before going to medical/nursing school we knew nothing about disease process- care and tx. after getting some knowledge we can now make sense of this medecine/science, therefore when patients come assuming they don't know what we owe to guide them in their care process and not over think about us taking the choice from them because we are not ! telling someone to drink water to keep hydrated is not taking their freedom of choice... just like advising a pt to comply with insulin tx is not imposing our choice or goal on them ! encouraging a diabetic pt to loose weight base on the data we have on hand is not being insensitive , if that what needed to get back on track with their health than it our job in the field to remind them of it knowing the right way to do this is what matter and will help in the end otherwise they wouldn't come to seek help in the first place. when the pt come to seek treatment to you ( hospital , dr , nurse ect...)they are saying clearly --i trust you to care and guide me with my health -therefore we have the duty to help them understand and follow the regimen which will help , unfortunately that implies meds, injections,surgery and all the ugly stuff we know is needed to fight disease.-although we should be taking into account before charting on a pt about their specific and individual habits on compliance to follow a prescribe regimen , i personally see it fit to communicate"compliant " or " non compliant " in charting in a way that will be clear and precise for others providers to realize how they should approach each pt base on that... it the word is offensive than there many ways to say pt didn't take or pt refuse meds 20 times ..... .yes the pt should be responsible for their care but when they come seeking help that means it is time for us to implement what we know and have learned to work for specific conditions and the disease . it seems to me that the confusion here in many post is letting the pt determine what should be done in their care , which defeat the purpose of science and medicine . we know insulin work to regulate glucose so the pt will have to agree or reject to have the insulin .if or when they agree than starting to choose when and when not to get their injection than " non compliant " will be appropriate .remember the only time there is a charting about compliance there was an agreement to the plan of care on bothe side pt& provider right? so if all of the sudden the pt starting to back up why not wanting to use the "dirty word"? . the pt coming to us asking for our professional advice and care , we give it and if the choose to back up after they have agreed that being non compliant hun???????????
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    Coming from a LTC perspective, we gave up the term non-compliant several years ago. We now use "choices" or "chooses". since we have orders, care plans and a multitude of other things in place to care for our resident and then they turn around even after the education and don't follow it. They choose.
    VivaLasViejas likes this.
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    Quote from nursesante'
    It seems to me that the confusion here in many post is letting the pt determine what should be done in their care , which defeat the purpose of science and medicine
    That's certainly the traditional view of medicine - we know best and the patient should follow along. However, our goal now is collaborative care - working out, with the patient, a plan that s/he can follow long-term, Ideally that's going to include all the things best practice recommends, and exclude all the things that are likely to be deleterious, but the point is that we advise and the patient decides. ""We know best" is a distressingly patriarchal concept.

    The definition of compliant (acquiescent, obeying the rules, esp. to an excessive degree) is passive and objective. What we want is patients who are active participants in their care, and a plan of care that's subjective and tailored tot he needs of that individual patient.
    VivaLasViejas likes this.
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    i see nothing wrong with using "non-compliant " or "compliant" these are terms chosen to help communicate among care provider . would it make a difference if a different term was used instead?
    yes, i believe it often would make a difference. far too often, noncompliant is medical-speak for someone who is being difficult and that can really set up a negative expectation for a practitioner who has never met the patient. it also reveals the strong possibility that someone (or many someones) have been engaging in a power struggle with the patient--a contest in which everyone stands to lose.

    i understand that at time the provider may jump to quick conclusion labeling of "non-compliant" a pt who wakes up on a random day and don't feel like taking her/his morning pill
    a morning pill? this indicates a poor understanding of the kinds of measures many diabetics are expected to take in their lives. a typical plan (i refuse to call it a regimen--another impositional word) can include half a dozen lancet sticks, many pills, a complex diet, exercise, possibly insulin and other tasks and expectations. if the diabetic has co-morbidities, there are likely to be more meds and other restrictions. and some of these "helpers" bring side effects along with them. this isn't a whimsical feeling of not wanting to take a pill or two.

    when the pt come to seek treatment to you ( hospital , dr , nurse ect...)they are saying clearly --i trust you to care and guide me with my health -therefore we have the duty to help them understand and follow the regimen which will help ,
    a newly diagnosed diabetic is probably not saying, "i trust you to care and guide me with my health." they are probably saying, "what the heck? how can this be happening to me? i don't like this one bit." if we don't give them some time to work through the emotions, if we rush to treat them while they're still reeling, chances are any help we can offer is going to be lumped in with the bad news. after all, who thinks it's good news that you have to change so many things about your life. if we wait at least a little while and give the person time to get over the shock, then we can give them information about what might lie ahead if their disease goes untreated. only then will they see the tools we have to offer them as helpful and not just more intrusions into their already upended life.

    i personally see it fit to communicate"compliant " or " non compliant " in charting in a way that will be clear and precise for others providers to realize how they should approach each pt base on that
    as i said, this is often shorthand for "difficult patient" and prepares other medical people to dig in and do battle. not a good start for new relationships.

    yes the pt should be responsible for their care but when they come seeking help that means it is time for us to implement what we know and have learned to work for specific conditions and the disease .
    if someone comes to us with a complaint of having to go to the bathroom all the time and we hit him with the news that he has a lifelong systemic disease that may kill him, we need to give him enough time to actually start seeking our help. with a great many people, that isn't going to happen the very day they get the diagnosis. but if we respect the need for a little time and space to process the information, that seeking can occur. that's if we, in our rush to rescue, haven't already shut it down.

    remember the only time there is a charting about compliance there was an agreement to the plan of care on bothe side pt& provider right?
    i would amend that to say the we chart about compliance when we came up with a plan of care and the patient didn't say no. that doesn't mean they were on board with it. we too often assume that an absence of visible resistance is the same as agreement. how many patients tell the doc or the nurse what they want to hear and then do their own thing. respectful care asks the patient to truly share their reaction. can they see themselves adhering to such a stringent protocol? would it be better to start exercising now and add some dietary changes next month? checking bg five times a day is a lot. how about twice a day. you can do more once you've got the hang of it. this is not the ideal, but it's better than the "nothing" that many patients do when it all seems too overwhelming.

    so if all of the sudden the pt starting to back up why not wanting to use the "dirty word"? . the pt coming to us asking for our professional advice and care , we give it and if the choose to back up after they have agreed that being non compliant hun???????????
    if a patient truly seems to be on board or they've been doing certain things and now they've backed off, i'd ask them what happened. and i'd listen to the answer. maybe they've been ill. maybe their spouse was laid off and they can't afford their meds. maybe they just needed a break. often, there are solutions when patients feel they can be honest. but if we just scold them and label them non-compliant, we could be adding to their reluctance to deal with their disease instead of being their allies in the fight.

    i like the idea of choices and choosing. i also like participating/not participating.
    Last edit by rn/writer on Jul 9, '12
    mcmgal, talaxandra, and VivaLasViejas like this.
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    My brother-in-law chose not to do his insulin for the past few months. Showed up on our doorstep 6 weeks ago with a foot infection for me to "fix" since I'm a nurse. 12 days in the hospital, 2 surgeries to remove all his toes, and then he moved in with us for awhile. He can't go home until he can go up stairs and take care of himself. At first I was emptying his urinal and waking up at 8:00 each morning (after working swing shift) to fix his breakfast. When I didn't get up, he fixed his own breakfast, slipped, bonked his foot and bled all over my floor. He's slowly healing and now sort of walking, but I've spent countless hours helping him over the past few weeks. All because of his noncompliance... oh, excuse me, his choices.

    He is now checking his blood sugar and taking his insulin and mostly making good food choices. Thank goodness for that. Please excuse my grumpiness. I need a bit of rest.
    Nurse& likes this.
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    RN/writer, I wish I could kudos your post twice - you beautifully articulated all the things I thought in response to that post. Thank you.
    Last edit by talaxandra on Nov 10, '11
  8. 0
    Quote from yrmajesty3
    OK...I see your points. We don't want to come off in a demeaning or patriarchal way towards our clients/patients. Also nurses acutely recognize that life-style changes are never easy. But, can you please tell me what you call it when a client/patient does not do what is at least minimally necessary for their well-being? If that behavior is not to be described as "non-compliant", what other word-smithing shall we use? It seems to me that politically correct wording doesn't help anyone get better.
    I agree that nurses should strive to try any angle of teaching that will successfully escort clients/patients to wellness. But when all else fails, what do you call it..... Failure to Effectively Motivate?

    Thank you . you at least see things the way i do
  9. 0
    A morning pill? This indicates a poor understanding of the kinds of measures many diabetics are expected to take in their lives. A typical plan (I refuse to call it a regimen--another impositional word) can include half a dozen lancet sticks, many pills, a complex diet, exercise, possibly insulin and other tasks and expectations. If the diabetic has co-morbidities, there are likely to be more meds and other restrictions. And some of these "helpers" bring side effects along with them. This isn't a whimsical feeling of not wanting to take a pill or two.

    Yes a morning pill ... i worked as Nurse in charge in a NH few years ago and i had some of the patients on Dr's order for 1 pill every day at 6 am . sticks , diet , insulin and all others being observed troughtout the day but I gave that 1PILL at 6 am per DR Order !

    I read the rest of your post your have your Views , i have mine . we can't think alike and some of the words you used i wouldn't .With that being said i found someone who think like i do below is her post

    "yrmajesty3 Re: The Dirtiest Word in Chronic Health Care
    OK...I see your points. We don't want to come off in a demeaning or patriarchal way towards our clients/patients. Also nurses acutely recognize that life-style changes are never easy. But, can you please tell me what you call it when a client/patient does not do what is at least minimally necessary for their well-being? If that behavior is not to be described as "non-compliant", what other word-smithing shall we use? It seems to me that politically correct wording doesn't help anyone get better.
    I agree that nurses should strive to try any angle of teaching that will successfully escort clients/patients to wellness. But when all else fails, what do you call it..... Failure to Effectively Motivate?"
  10. 0
    "Failure to Effectively Motivate?" i like this lol......
    i wish i could kudo your post 5 times.


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