When clients ignore medical advice, do not follow doctors’ orders, or refuse to participate in recommended activities to improve health, they are said to be not conforming. Do your nursing assistants know how to handle clients who cannot or will not adhere to their plan of care? Here is basic information to keep your CNAs informed.
What does it mean when a client does not comply?
Having a client refuse to follow your treatment plan can be very frustrating. It can make you feel like you’re doing a lot of work for nothing! Clients who do not follow physicians’ orders are considered “non-compliant”, although this term is slowly being replaced by the term “non-adherence”.
Because? The dictionary defines non-compliance as “the lack of obedience”. This term seems a bit awkward for our modern society. Our goal is that customers want follow orders for their own well-being… but they shouldn’t feel like they have to do it blindly. achieve in all circumstances!
Adherence, on the other hand, implies a agreement between the client and the medical team that the suggested treatments are valid, valuable and necessary for optimal health.
When you reframe the issue of compliance as one of adherence, you’ll see that the solution lies in compromise, understanding, and mutual agreement on a common goal.
However, until an agreement is reached, the problems associated with adherence or non-compliance are serious and can even lead to death. Here are some facts:
- Nearly 70 percent of hospital admissions and 23 percent of nursing home admissions in the United States are the direct result of noncompliance. This makes non-compliance the largest and most costly “category of disease.”
- In Europe, non-compliance causes almost 200,000 deaths every year.
- One study found that “many people with chronic illnesses don’t take your meds with the prescribed frequency, and that non-compliance can cost up to $300 billion per year to the health system”.
What about patient rights?
One of the most basic rights of patients is the “right to participate.” This means that all patients/clients/residents have the good to:
- Make decisions about your own care.
- Change your mind about health care treatment and services.
- Refuse care (after being told what might happen if they refuse).
- Have advance directives if they wish, including a living will and/or health care power of attorney.
- Along with this right, patients have a responsibility to:
- Ask for more information if you don’t understand something.
- Go to all scheduled medical appointments.
- Follow the care plan they help create.
- Provide your workplace with a copy of your living will or other advance directive.
As you do your daily care, it is important to balance the rights of your client with his desire to comply with the plan of care. Here are 7 tips to do just that:
- Allow your clients to decline care if they wish, but be sure to document the situation and/or inform your supervisor.
- Be aware that a client’s health insurance may have rules about paying for care that the client keeps refusing. For example, if you are a home health aide for a client with Medicare insurance, Medicare may deny payment for your services if, day after day, the client refuses to let you help with personal care.
- Follow any advance directives. For example, if your client has a “Do Not Resuscitate” order, make sure you know what to do if they stop breathing during your care.
- Get used to explaining what you are going to do with a client.before you do it. Your customers will be better prepared and more likely to comply if they know what’s going on. For example, explain to Mr. Wilson that you are going to help him change positions in bed.before you put down his blanket and sheet!
- Remember that all adults have the right to choose where and how they want to live, even if that environment seems unsafe or unhealthy to us. For example, Mr. Brown lives in a house without electricity. You may think that Mr. Brown would be healthier if he could refrigerate his food, but he has lived in his house for twenty years and sees no reason to change now.
- Never threaten your customers into compliance. For example, it is incorrect to say, “If you don’t take a bath right now, you won’t be able to watch TV this afternoon.”
- Don’t force care on a client even if you know the client will be better. For example, you can’t force a customer to eat lunch even if you’re concerned that he or she has lost a lot of weight lately. (But be sure to document the fact that the customer refuses to eat.)
Why some clients do not comply?
There are many reasons why your client may not follow a treatment plan. Sometimes it’s for a combination of reasons Here are some of the most common causes of non-compliance with the plan of care:
misunderstandings. Medical professionals speak their own language and can easily confuse non-medical people. Your client may not follow the orders because the orders were not explained clearly or in a way that made sense.
Disability. Sometimes a treatment may simply be physically impossible for your client. To make matters worse, some customers may not be willing to accepted they cannot perform a certain task.
Depression. There is a grieving process that occurs when a client is given a serious and/or life-changing diagnosis. Sometimes this complaint can make the client too depressed, which can interfere with the ability to make rational decisions.
Cost. Even with insurance, the cost of some treatments and medications may be too high for your client.
past experience. A negative experience with a treatment or medication can lead a client to not comply. Additionally, a negative past experience for a loved one may also influence a client to ignore or reject medical advice.
Lack of control. The need to depend on others to complete life’s basic tasks can make your client feel vulnerable and helpless. Combine that feeling of helplessness with doctors and nurses who don’t always ask the client’s opinion about treatment. When clients feel they are not in control of their environment or treatment plan, they may not willingly participate.
Lack of knowledge. Doctors and nurses have an obligation to explain diseases and their treatments to clients in a way that meets the needs of each individual. However, information is not always communicated effectively. Language, cultural differences, stress, and education level can interfere with a client’s understanding of the disease process.
altered mental state. Clients with an altered mental state can appear, at times, to be non-compliant. But, this situation is different for all the others since it is not considered intentional breach. In other words, the customer is not necessarily responsible for choosing not to comply. This means that simply explaining the situation to the customer will not work!
Remember…
No one wants to be ordered around or told what to do! Involving clients in the care plan will increase the likelihood that it will actually be successful!
All customers have rights. These include the right to participate in your own care and the right to refuse treatment.
Change is hard! It is not enough to tell customers that they have to make a change. They must be motivated to make the change on their own time…and on their own terms.
Give clients a head start by removing barriers to compliance such as cost, access to care, and physical ability to comply.
Providing emotional support, praising every effort, and working on mutually agreed upon goals will give your client the strength and confidence to achieve optimal health.
