_________________________________________________________________ Managing Disruptive Patients
INDEPENDENT HEALTHCARE PROFESSIONAL INTERVENTIONS FOR PATIENTS WHO ARE NONADHERENT AND THEIR RATIONALE
Independent Healthcare Professional Interventions Develop awareness of feelings toward patients who are nonadherent with their treatment regimens.
Rationale
If unaware of personal feelings toward patients who are nonadherent, there is the possibility to be unaware of feelings of anger and/or powerlessness toward patients. This may a withdrawal from the patients and thus their needs will go unmet. Trust is basic to a therapeutic relationship. The quality of the healthcare professional-patient relationship has been shown to be a powerful predictor of adherence. Several studies have shown that clinical depression is a risk factor for nonadherence (Stewart et al., 2023). A complicated or demanding treatment plan is an ordeal for even the most motivated patients. Patients need to understand why the plan is necessary; otherwise, they have little incentive to follow through with it. The mutuality of expectations of patients and healthcare professionals makes it more likely that patients will be adherent with the treatment plan. Encourage patients to ask questions and express their concerns regarding their illness and the advantages and disadvantages of a treatment regimen. Addressing issues and strategizing with the patients as to how best to deal with these issues will help with adherence and help to reinforce the importance of the treatment plan. To be able to adhere, patients must understand the information presented to them: • Teaching should be brief and focused. • Complex information should be broken into smaller, more understandable parts whenever possible. • Teaching material should be simplified as much as possible. Aim for a reading level of fourth or fifth grade with few words with more than three syllables. Patients often have valid reasons for not following a treatment plan. The better the understanding of patients’ concerns about their treatment regimen, the more likely its importance will be explained (Jones et al., 2015). If family members or other caregivers are not providing direct care to patients,and if patients are having difficulty following through on taking medicationsor other therapies, family members may be helpful in reminding patients to take their medications. The healthcare team may detect and help solve nonadherence problems, including health system problems as well as patient issues. Table 3
Develop a trusting relationship with patients.
Assess patients' mental status.
Explain clearly why the treatment is necessary and what to expect (e.g., delayed benefits, general side effects). Ask the patients to identify benefits of treatment and how likely they think it is that there will be consequences of the current illness or health problem (perceived susceptibility and perceived severity). Include the patients in setting goals and planning care. Ask the patients to identify potential barriers to adherence (e.g., social, economic, or environmental factors).
Teaching should be aimed at the patients’ learning level.
Encourage patients to report problems with their treatment regimen, such as any unwanted orunexpected side effects, before adjusting or stopping it.
Encourage patients to request the support and help of family or friends.
Communicate concerns about thepatients’ nonadherence with othermembers of the healthcare team.Revisit the facility’s philosophyabout patient-centered care.
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