Nursing priority question...

[swflNurse]

I'm an LPN in an ADN program.

I'm doing a nursing case study. Patient Nursing Dx's I have come up with are impaired skin integrity, non-compliance, constipation, chronic pain, and impaired verbal communication (non-native tongue speaker). I've looked at Maslow's Hierarchy and researched them.

My thoughts are that pain won't be able to adequately be able to be achieved if the patient isn't compliant, so pain isn't going to be #1.

Impaired skin integrity is a possible #1 but I don't believe a non-compliant patient will adhere to treatment plan which would include ambulation.

Constipation is definitely in the top 4, but wouldn't be #1 when a lot of the measures above could aid in promoting bowel movements.

Impaired verbal communication is an important Dx but wouldn't be above the others due to Maslow's.

Feelings on Non-compliance being #1?? Is it a possibility? That's how I'm leaning due to the fact interventions for the other DXs won't be possible without compliance, ie ducolax for constipation, ambulation for a couple of them, medications for pain, etc. Thoughts. Sorry, if this doesn't make sense I've been beating my head against my desk.

[minnymi]

as a brief clarification, the term "compliance" is no longer acceptable in this context and does not appear in most contemporry literature. "to comply" means to follow orders; this removes the concept of patient choice and make the patient the unacceptable one in the equation if he chooses not to follow them. the patient always has the choice to participate in the treatment plan someone else derives; it would be better if the patient were an active member of the team deriving the treatment plan, because this would increase the chances of success. this component of both nursing plans of care and medical plans of care is often forgotten.

but for now, when the team makes the plan and attempts to implement it, the patient makes the choice to adhere to it. then the question becomes, how do we foster patient adherence to the plan?, not, how do we make him follow our orders?

this is true. adherence is the new word, but so is "client" instead of patient.