Noncompliance

[BabaLouRN]

Does anyone have any ideas about noncompliance. If it were up to me I would discharge immediately BUT... can't be done at my current job, we are supposed to keep them on for teaching. There are some things you can't change. I am now on my 4th job in Texas because I leave to search for an agency with enough backbone to do things correctly according to Medicare guidelines. Apparently this "keep the numbers up" is the norm for this state. I am tired of job hopping and I need the job. I also have issues with patients who think "It's your job, I'm not a nurse"

[KittyLovinRN]

I generally give the patient 3-4 weeks of teaching (approx 2x week). If they cancel visits, dispute every bit of information that comes out of my mouth and are obviously non-compliant (i.e. insulin -- I search everybody's glucose meter, so many lie about their numbers) I call the doctor (usually with really bad ones I call once a week to let them know I'm getting no where and when my end point is) and tell them there's nothing more I can do. 99% of the time they knew it was a lost cause but had to try (which I can understand) and I go on my way. My agency is pretty in line with my routine, they've never given me a hard time about numbers, we have more patients than we know what to do with. Just make sure you communicate with MD and DOCUMENT every single thing going on to back yourself up later!

Good luck!

[KelRN215, BSN, RN]

Sigh, this is a problem I encounter regularly... in fact, it's often the reason we're in the home in the first place. The trick is that I'm in pediatrics so the child is the patient while the parents are the ones who are non-compliant. I communicate with these patients MDs regularly and, if necessary, report to the state. Adults are free to be non-compliant for themselves, they are not free to make those decisions for their children.

[Ashes172, BSN, RN]

If the parents are non-compliant then maybe DHS need to be involved?

[KelRN215, BSN, RN]

If the parents are non-compliant then maybe DHS need to be involved?

Yes, that's why I said I report to the state when necessary.

[nurseprnRN, BSN, RN]

We don't call it "noncompliance" anymore. It's "nonadherence," as in, the patient chose not to adhere to the medical or nursing plan of care. Of course, they are completely entitled to do that. "Comply" has explicit overtones of force or orders from a superior, and that's not what we're about in healthcare.

That said, though, if someone doesn't want to adhere to a plan of care he/she agreed to at admission, and you can't work with him/her to see why and what would work better for him/her, then by all means, have a patient contract that says your agency will discharge him/her.

[dishes, BSN, RN]

When it comes to healthcare teaching, I stopped using terms like non-compliance and non-adherance about 10 years ago, instead I use the terms like shared decision making and full informed consent. My goal when I teach, is not to have the patient comply with the recommended treatment plan, but to have the patient and family demonstrate or verbalize their understanding of the risks and benefits of their healthcare choices.

I think my attitude about educating patients has evolved over the years, during my base nursing education, I was taught what to teach, but not taught how to teach patients and families. Over the years I have become informed about patient education and as a result I view the "non-compliant, non-adherant patients in different light. I enjoy trying to find ways to teach in a style that a patient can best learn from. I try to get them to teach back the information to me, so that I can be assured that they truly do understand and are making informed choices.

[KittyLovinRN]

When it comes to healthcare teaching, I stopped using terms like non-compliance and non-adherance about 10 years ago, instead I use the terms like shared decision making and full informed consent. My goal when I teach, is not to have the patient comply with the recommended treatment plan, but to have the patient and family demonstrate or verbalize their understanding of the risks and benefits of their healthcare choices.

I think my attitude about educating patients has evolved over the years, during my base nursing education, I was taught what to teach, but not taught how to teach patients and families. Over the years I have become informed about patient education and as a result I view the "non-compliant, non-adherant patients in different light. I enjoy trying to find ways to teach in a style that a patient can best learn from. I try to get them to teach back the information to me, so that I can be assured that they truly do understand and are making informed choices.

I really like your viewpoint, excellent advice for less experienced nurses!

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[dishes, BSN, RN]

kittylovin, I like this view of patient education too and have read literature that promotes this view, if you are interested in reading more, I suggest you start with the book "No time to teach" by Fran London.

[KittyLovinRN]

kittylovin I like this view of patient education too and have read literature that promotes this view, if you are interested in reading more, I suggest you start with the book "No time to teach" by Fran London.[/quote']

It's on my kindle ready to read now, thanks!

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[anothergrumpyoldRN]

Generally, humans have a learning curve.

It is a different curve for adults because they may have pre-existing notions or behaviors that hamper their ability to practice new concepts and behaviors.

Establishing a plan for repetition and development of trust is necessary.

After you have completed the time frame, evaluate for compliance and skill...are they non-compliant because they are unable or uninterested? were your methods successful? Should the plan be changed or should the patient be discharged?

Home care is NOT acute care.