What to do when a patient doesn't listen?

[cc290133]

Depending on where you work as a nurse you may see the same patients frequently. Either admitted in the hospital, ER, or in a clinical. As a nurse you want to advocate for your patient. Educate them on what is best for their health and provide them resources to improve. What do when you get a patient who doesn't take advice, doesn't stick to medication directions, and refuses to make changes? How can you motivate your patients?

[brownbook]

There is no easy magical answer.

One end of the spectrum is think they are adults, this isn't prison, they can do,what they want, let it be.

The other end is work on therapeutic listening, ask open ended questions. "I feel frustrated when I have to remind you about checking your glucose....I want to know what you think about your your diabetes, (or your health, or your high blood pressure)?" Have a blank piece of paper and write down everything they say. Ask if they will listen to how you feel. "I know it shouldn't bother me but it does."

Ask if they have any ideas, solutions?

Or ask Dr Google how to talk/listen to non-compliant patients.

[Nurse SMS, MSN, RN]

I give them the information they need, document that it was given, document patient reaction/questions/lackthereof and then I move on. Motivation is largely internal. The best we can do sometimes is provide nonjudgmental care and meet the patient where they are at. There are many things that play into motivation, including socioeconomical status, psychosocial support, overall health condition, accessibility of care, upbringing, etc etc etc. The variables are endless.

[pro-student]

Based on you wording, I'd suggest you have the wrong approach. People rarely like to be told what to do, take directions from strangers, and make changes in their lives based on what someone else thinks they should do. "We tend to believe what we hear ourselves say." And definitely more so that what other people try to convince us (regardless of whether or not they have letters behind their name). Getting patients to talk things out themselves rather than talking at them is key.

The golden RULE of motivation:

Resist the righting reflex by assuming you know what is best for someone and can fix things by just saving them from themselves (even though this is sometimes 100% true, its never going to change anyone)

Understand your patient's true motivations. Everyone has their own priorities which dictate their motivation. Tapping into their own motivation is the only real way to get people to do anything.

Listen to you patient. Get them talking about what they would like to change and how they think they can do it. People are much more likely to act on an idea you guided them to or a plan you helped them come up with than directions you dictate at them.

Empower you patient. Celebrate little victories. I praised a pt once just because they told me they were considering quitting smoking but hadn't decided if they wanted to yet. My co-workers thought I was crazy but guess who that pt came to when they were ready to quit.

Prochaska and DiClimente have done a lot of great work on the Transtheoretical Model of Behavior Change. It's all about supporting people through the stages on change rather than rushing them through before they're ready. If you're really into this topic, google Motivational Interviewing. Or better yet, find a copy of Motivational Interviewing in Healthcare: Helping Patients Change Behavior by Rollnick, Miller, and Butler. Its

[Tenebrae, BSN, RN]

Based on you wording, I'd suggest you have the wrong approach. People rarely like to be told what to do, take directions from strangers, and make changes in their lives based on what someone else thinks they should do. "We tend to believe what we hear ourselves say." And definitely more so that what other people try to convince us (regardless of whether or not they have letters behind their name). Getting patients to talk things out themselves rather than talking at them is key.

The golden RULE of motivation:

Resist the righting reflex by assuming you know what is best for someone and can fix things by just saving them from themselves (even though this is sometimes 100% true, its never going to change anyone)

Understand your patient's true motivations. Everyone has their own priorities which dictate their motivation. Tapping into their own motivation is the only real way to get people to do anything.

Listen to you patient. Get them talking about what they would like to change and how they think they can do it. People are much more likely to act on an idea you guided them to or a plan you helped them come up with than directions you dictate at them.

Empower you patient. Celebrate little victories. I praised a pt once just because they told me they were considering quitting smoking but hadn't decided if they wanted to yet. My co-workers thought I was crazy but guess who that pt came to when they were ready to quit.

Prochaska and DiClimente have done a lot of great work on the Transtheoretical Model of Behavior Change. It's all about supporting people through the stages on change rather than rushing them through before they're ready. If you're really into this topic, google Motivational Interviewing. Or better yet, find a copy of Motivational Interviewing in Healthcare: Helping Patients Change Behavior by Rollnick, Miller, and Butler. Its

Good suggestions.

I've lost count of the cases of patients non compliance to treatment regimes and when digging a little deeper, I find out that the patient had to make a choice between paying to put food on their kids table, or paying for their own prescription, they'll choose to feed their children

[FolksBtrippin, BSN, RN]

My job is all about dealing with non-adherence. I work in community psych with people who have been resistant to traditional treatment modalities.

You got really good references from pro-student, motivational interviewing and transtheoretical model (mostly we call it stages of change). Those are both evidence based practices-- what we do.

I would say, first look at stages of change. Your first goal is going to be to figure out what stage of change your patient is in. Usually a non-adherent patient is in pre-contemplation or contemplation.

Pre-contemplation means the patient does not see a problem or recognize a need for change. When patients are in pre-contemplation we focus on reducing harm, building trust and rapport and identifying barriers to adherence... very gently. It is important not to express frustration or argue with the patient over their life decisions. But instead, to look for those life decisions that you can support. For example if your diabetic patient refuses metformin and diet changes and doesn't believe that he really has diabetes, but likes the idea of a walking club, just talk about the walking club with him.

Contemplation means the patient knows change is necessary and is intending to make a change in the next 6 months. The patient is weighing pros and cons. Here is where motivational interviewing really helps. By talking about his feelings about change, reservations, pros and cons with a non-judgmental listener who asks key questions that develop his ideas, the patient can move faster along the change process.

[morte, LPN, LVN]

as a hearing impaired person, my first thought is, make sure they can hear and understand you...

[Penelope_Pitstop, BSN, RN]

Have you ever read up on motivational interviewing? It's a technique used in the behavioral health field and can be very helpful with non adherent patients.

An example...

"Mr Jefferson, you listed all of the reasons why you don't watch your carb intake and I understand that's it's really difficult to do it. But what good things could happen if you did control your glucose levels?"

Also, speak with the patient in his or her own language...if the person doesn't understand medical jargon, don't throw it around as if you are intellectually superior. I'm sure the patient could teach you about his profession! (I'm not saying you're doing this, I'm just throwing it out there."

And, validating his or her feelings/rationale, et al, as well vs dismissing them. So, when a patient lists a negative feeling towards a lifestyle change, or medication or diagnosis, don't begin a response with "at least," or "but." First, acknowledge that the person's feelings are valid.

[hppygr8ful, ASN, RN, EMT-I]

Aside from the very good advice you have been given here when all else fails document your teaching and your patient's verbalized response and move on, You cannot save the world so you shouldn't drive yourself crazy trying.

Hppy

[Accolay]

Yell harder? :)

The cynical side of me says that you only have a small amount of time with each pt and even if you make your time count, it's usually not enough. I also believe that motivation comes from within. So the best you can do with your limited time is make sure they are going home with at least the basic information, a follow up appointment is scheduled and you have their phone number in the chart. Change is hard. Hardest for people who don't have the means.

[TheSquire, DNP, APRN, NP]

See, I could dig to find out why each poorly-adherent patient from our largely indigent population isn't complying with their treatment modality...but what would that do? I don't have access to any resources to improve my patients' non-clinical problems, and my institution is actively resistant to assigning 24-hr Social Work to the Emergency Department, despite the known benefits. We haven't even had bus passes for months, and the direct phone line to the local cab company in the entryway has been broken for about as long.

All I can do is make sure my patients know what their diagnosis is, what they need to do, and what the signs are that they need to come back; the rest is up to them.

[T-Bird78]

I worked in allergy/asthma, so noncompliance was nearly a daily encounter. In reviewing their medication list, I'd ask if they were using their maintenance inhaler daily, not just "are you taking your inhaler" because that's a trick question. If they weren't, I'd remind them that their daily inhaler keeps them from needing their rescue inhaler frequently. If they tell me they coudln't afford the copy, I'd get a sample for them, give them the copay assistance card, or ask the provider to switch rx. My allergy pts were another story because they didn't take their food allergies seriously or thought benadryl before eating their known-allergic food would help. I'd explain that the EpiPen may be expensive but they'd rather have it and not need it, than the other way around. If their EpiPen was at home or at work, I'd remind them that their desk drawer isn't the one with throat closing up and SOB, and same for the glove compartment (and the epi can actually deteriorate if left in heat, like a hot car). A lot of times pointing out the cost of the rx copay is cheaper than frequent office visits and ER/paramedics it helped. Document everything.