_________________________________________________________________ Managing Disruptive Patients
Treatment adherence is usually associated with optimal health. The most obvious result of nonadherence is that the disorder may not be relieved or cured. For example, when patients with glaucoma fail to take their prescribed medications, optic nerve damage and blindness may be the result. For patients with an erratic heart rhythm, failure to comply with suggested treat- ment can lead to cardiac arrest. Stroke may be the outcome when people with high blood pressure ignore prescribed treat- ment. Failing to take prescribed doses of an antibiotic can cause an infection to flare up and may contribute to the emergence of drug-resistant bacteria. These failures to follow healthcare suggestions are not only frustrating but are also costly because of the undesired patient outcomes.
Self-Assessment Quiz Question 7
What response is most likely accurate and helpful to Jackie? E) “We really can’t say.” F) “It’s hard to know. What do you think?” G) “Some people are just that way.” H) “It is not possible to say accurately why Erik is behaving in this manner.” The correct answer is D. Rationale : Jackie is seeking answers to help her understand Erik’s behavior. At this point, there is not a definitive answer to Jackie’s question. The interventions in plan will help the team to gather more information to better understand Erik’s behavior. The nurse manager may also tell Jackie, “Often patients will react aggressively but the staff has no sure way of knowing why this happens. It could be that the ‘mood swings’ mentioned by the daughter are connected to Erik’s current behavior. It might be the unknowns of the hospital process or of what the findings from his surgery will indicate. The fact that Erik does not speak English well may increase what might be normal anxiety to a frightening level.”
Sometimes, patients who need to take medication regularly are the ones who are the most worried about addiction. In some cases, the family is also worried that their loved one will become addicted. In many cases, prescribed drugs are reducing symptoms, not curing the disease. Many
psychiatric medications reduce symptoms, but, from the patient’s perspective, the side effects seem to be worse than the symptoms. When patients begin to feel better, they stop taking their medication. After a period of time without the medication, the symptoms return, and the patients must start the cycle all over again. Education of patients and their families is critical in helping them understand why they are taking their medications, the expected side effects, when there is reason to be concerned about developing tolerance or dependence, and that continuing the medication is what will make them continue to feel better. A similar situation exists in the frequent nonadherence with antibiotic treatments. Although patients are told to take the entire prescription, they often stop once they feel better. Again, education is the key to patients’ adherence to treatment. Verbal instruction followed by giving the patient a written pamphlet is often necessary to achieve adherence. INCIDENCE Although it is almost impossible to correctly determine statis- tics related to nonadherence, estimates have been made. It is estimated that the financial burden on healthcare systems in the U.S. is $528 billion per year (Poonawalla, 2024). In addi- tion, it is estimated that around 20%-30% of new prescrip- tions do not get filled. There is evidence that the presence of comorbid conditions, such as depression, anxiety, and drug or alcohol misuse, can negatively impact adherence (Stewart et al., 2023). Medication nonadherence leads to poor health outcomes, increased health costs, and increased health risks for individu- als and populations. Misuse and overuse of antibiotics have contributed to the emergence of antibiotic-resistant strains
Self-Assessment Quiz Question 8
What guided everyone on the staff and facilitated the positive outcome? A) No one person tried to tell others what to do. B) Everyone on the staff liked and felt sorry for Erik. C) Jackie had a lot of previous experience dealing with aggressive patients. D) The staff all kept in mind that the most important thing is to provide a safe environment. The correct answer is D. Rationale : Preventing harm to the patient and staff and providing a safe environment is important. This is precisely what the nurses and other staff in this scenario did. They focused on the needs at hand and implemented appropriate interventions based on the observed behavior. NONCOMPLIANCE There is some debate among healthcare professionals regarding the concept of noncompliance (Stewart et al., 2023; Townsend & Morgan, 2017). Healthcare professionals have argued that a diagnosis of noncompliance labels the patient negatively, arguing that it places the emphasis on the patient’s behavior instead of on a mutual process with the healthcare profes- sional and other healthcare providers. At the heart of this argument is the issue of the right of the patient to choose a treatment course that is different from the recommendations of the healthcare team.
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