the "non-adherant" patient question

[HHNurse<3]

Hi all,

As a new HH nurse, I was wondering what your organization's standards are. For example, if you have a patient who is not taking their meds or not following treatment guidelines, how do you deal with this? How long would you give them to change their behavior before discharging them from the agency? Do you all have any tricks, or especially helpful interventions that you use? I work in an urban environment and have been encountering this problem quite a bit which is sad to me since these are exactly the type of people that need our help. It is too bad that agencies "give up" on these patients and will not allow nurses to continue to try and educate their patients.

[Silverblitzen]

"It is too bad that agencies "give up" on these patients and will not allow nurses to continue to try and educate their patients."

Hi Anna,

You can only do so much with the time you have. For every one of the non-compliant clients, there are so many more that will love to see you, listen to what you say and care about their health. I'd say a safe measure would be the 3 strike rule - 3 teaching/reinforcement sessions and if they still don't follow the med regimen, they're discharged. Save your energy for those that care enough about themselves to follow what you're saying.:selfbonk:

If there are other obstacles to their understanding, then other agencies may have to be called in, but you, as HH nurse, only have so much energy to give. Give it to those that are trying to help themselves because you'll soon find yourself burned out trying to force someone to be compliant who just doesn't give a rat's patootie. And you'll resent them which is counterproductive to that therapeutic relationship we're all supposed to have. So, rule of three and set them free! Yah!

Best,

Sue

[vkunurse94]

Be patient!!!! Work with the client. TEACH...TEACH...TEACH on the importance of sticking with med regimen. A lot of times patient's are taking meds and don't even know why!!!!!!!!! Help them understand the rational for each med and the consequences of not following these orders. If after a cert or two, you see that you are getting nowhere, it may be time to discharge. Sometimes it is just ignorance and/or poor teaching by various health care employees. Give your patient's a chance! If they obviously don't have any desire to change or receive help.....it is time to discharge.

[NYHomeRN]

:twocents:I have a patient on service now its been almost two months and I'm getting ready to discharge her. She has a long history of medication noncompliance as per her vital signs and her sister's reports but she always insisted she was taking her medication. Her wounds healed, which was the reason we got called in on the case to begin with. But finally this patient began showing signs of trusting me, and I decided to stay in once a week for some serious medication management, just for three weeks. I have been able to get her to buy a new more appropriate medication organizer, and last week she let me sit with her and prefill it. This week she will do it with me there. The woman is very difficult, forgets what you say from week to week and is on Haldol and Prozac when she takes it. Her spouse is oblivious to problems except to say "she thinks she's being funny". I don't give up easily, maybe this last week will stick, maybe it won't. The MDs on the case are aware but have no answers, we are the ones in the environment.