Nursing Student Needs Help To Teach About Med Non-compliance

[InmyblooD]

I am going to be doing a 10 min. teaching session with a client at my clinical rotation about medication non-compliance. The patient's diagnosis is a schizoaffective disorder, bi-polar type; polysubstance abuse; antisocial personality disorder. The client takes all his meds (Depakote, Haldol, Zyprexa, and Lovoxyl) while on the unit and dispenses them himself, however outside of the hospital, the client is very non-compliant and stated that he didn't need to take the drugs but takes them in the hospital because he has to.

My purpose of this session is to teach some things to the client about his non-compliance. But if he isn't going to take the meds outside of the hospital, what angle should I take for this??

I only had about 10 minutes to talk to him about why he doesn't take his meds outside and he says that he djust doesn't need to take them. He knows what exactly he's taking and what each drug does.

I just don't know what kind of teaching I can do to improve his compliance and how to implement it.

If anyone can help me, it would be so helpful because I'm in the dark right now.

Thanks in advance for the help!!!

Chris S.

[rn/writer, RN]

After years in psych nursing, I can tell you this is a tough one.

The hard truth is that you can't make anyone be compliant. I'm not too fond of that word anyway as it implies that WE are in charge and we really are not.

What you CAN do is get your patient talking. Ask him what his goals are and how the meds help or hinder his progress. Find out what stops him from taking the meds. Does he really think he doesn't need them or does he not like how they make him feel. See if he has any kind of a safety net in place--people whose judgment and motives he trusts who will let him know when he's showing symptoms. Ask if he knows the range of symptoms he might have to deal with--he may not have experienced all of them yet.

If you approach him with the clear understanding that you know you can't MAKE him do anything, but that you want him to be informed about his choices and their possible outcomes, you might be able to plant a few seeds for the future. And he might let his guard down a tiny bit and develop a little trust.

I wish both of you well.

[IMustBeCrazy]

After years in psych nursing, I can tell you this is a tough one.

The hard truth is that you can't make anyone be compliant. I'm not too fond of that word anyway as it implies that WE are in charge and we really are not.

What you CAN do is get your patient talking. Ask him what his goals are and how the meds help or hinder his progress. Find out what stops him from taking the meds. Does he really think he doesn't need them or does he not like how they make him feel. See if he has any kind of a safety net in place--people whose judgment and motives he trusts who will let him know when he's showing symptoms. Ask if he knows the range of symptoms he might have to deal with--he may not have experienced all of them yet.

If you approach him with the clear understanding that you know you can't MAKE him do anything, but that you want him to be informed about his choices and their possible outcomes, you might be able to plant a few seeds for the future. And he might let his guard down a tiny bit and develop a little trust.

I wish both of you well.

:yeahthat:

50- 60% of all the admissions on my unit are due to med non-compliance. It is THE most difficult thing to address. Unless a pt is court-ordered to take their meds, there is honestly nothing we can do besides try to tell them (AGAIN) about their meds. I agree asking them/listening to them is the best. There is a percentage of these "non-compliance" pts that actually LIKE being off their meds - they've been sick so long that when their mind is clear/they are calm it's actually upsetting to them. Best of luck!

[Morgan314]

There are so many reasons for noncompliance with medications. A Patient who has no insurance, Medicaid, Medicare part D or other prescription med coverage cannot afford the medications. All the meds you listed for this patient are very expensive. You might want to be sure he has access to the medication after discharge. I work in a community MHC and find many patients coming to us for follow-up have no way to pay for meds. Those who do have prescription drug coverage still have trouble coming up with money for co-payment.

Some patients say they don't take their meds "because of the way they make me feel," but are reluctant to identify anything specific such as sexual side effects or leaking breasts. Also, Depakote and Zyprexa can cause a lot of weight gain and many patients stop meds for that reason.

Sometimes it helps with compliance if the meds can be taken once a day. Would his prescriber consider this? I can't always remember to take my morning Adderall, and sometimes don't remember if I did take it, but I find it easier to take my hs med because it comes in a blister-pack, with the days clearly marked, and I have a routine of taking it before I brush my teeth. Having a routine activity to associate with med dose time is helpful. What are recommendations for follow-up after dschg? Encourage him to follow through with dschg recommendations and to establish good rapport with his outpatient treatment team (especially his nurse) who can assist with compliance.