_________________________________________________________________ Managing Disruptive Patients
Healthcare professionals need to be sensitive to the unique needs of this age group. SOCIAL AND ECONOMIC RISK FACTORS The social spheres that most affect a patient’s health behaviors are: 1. Family and significant others 2. Relationships with healthcare providers 3. Cultural or ethnic groups 4. Religious community or beliefs 5. Economic status Patients are more likely to adhere with their treatment plans if their family or significant others are supportive of it and encourage them to follow it. They are also more likely to be adherent if they have a positive relationship with their health- care team, are included in the decision-making process, and are acknowledged for being adherent. A patient’s cultural or religious beliefs and practices may pro- hibit adherence with a treatment regimen. In some religions, use of certain types of medical interventions is regarded as a lack of faith in God, and those interventions are therefore prohibited. Some cultures have lay healers, and the patient may wish to combine the healer’s cures with medical treat- ment. Many cultures view healing as a family affair; therefore, the family will always need to be present and involved in the patient’s care. Healthcare professionals must try to understand and appreciate the importance of these practices to help patients be adherent. A significant concern related to nonadherence is limited income. Patients may have hospitalization coverage but lack sufficient funds to follow through on recommendations after discharge. A patient who must choose between feeding their family and buying blood pressure medicine has no choice at all. This is particularly true for older adult patients who are frequently on fixed, limited incomes. Choices between food and medication are not easy ones, and healthcare professionals can help access as much assistance as is available to older adult patients. It is helpful to examine older adult patients’ finances with them and plan realistic healthcare choices together. ENVIRONMENTAL RISK FACTORS The healthcare setting can influence patient adherence. The most common factors are comfort issues and ease of access, including transportation. The needs of patients who are physi- cally impaired must be considered carefully. For example, an older adult who has been directed to return to the clinic after a surgical admission may not keep this appointment. The patient may not have transportation, the parking may be remote and require walking a long distance between the parking lot and office, or the stairs may be too much to handle. If there is little to motivate patients’ return, then when they are feeling well, environmental obstacles will result in nonadherence.
Determining risk factors early in treatment enables healthcare professionals to intervene effectively. Healthcare professionals are in the best position to use their skills to develop a care plan with the patient that maximizes adherence. In the same way, knowledge of risk factors affecting compliance can enhance discharge planning and make it more effective. Situational factors are best dealt with through anticipatory planning. A conversation with the patient about the possibility of these events occurring and how to deal with them can ensure their adherence. A patient on a restricted diet, for example, is asked to consider eating at home until they are familiar with the diet. The patient is also given ideas about what to order in a restaurant that would be allowed on this diet. The patient may feel uncomfortable explaining their diet to friends. Role playing can be helpful in these situations.
Self-Assessment Quiz Question 9
Bill is a 32-year-old, single African American man diagnosed with bipolar disorder who stopped taking his medications 3 weeks ago. His family brought him into the emergency depart- ment because of his manic behavior. The healthcare professional caring for this patient knows that: A) Most drugs for psychiatric illnesses have few side effects. B) The severity of side effects for antipsychotic drugs varies according to their gender. C) A bipolar patient often stops taking their medication when they are manic. D) Medications for bipolar disorder have few side effects. The correct answer is C. Rationale : Patients who are experiencing mania feel highly ener- gized and motivated during this phase of their illness. They believe they feel well, although they often have anxiety and inappropriate behaviors such as compulsive spending or numerous unfinished products.
Self-Assessment Quiz Question 10
To avoid medication noncompliance in the future, the health- care professional should: A) Limit disclosure of the severity of the illness to the patient and family. B) Encourage the patient to purchase needed medications at their own expense. C) Use scare tactics wherever necessary to obtain compliance. D) Teach the family some of the symptoms that would show medication nonadherence early.
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