_________________________________________________________________ Managing Disruptive Patients
have placed him at risk for more falls and other physical problems. In this example, the staff needed to learn to look beyond Michael’s nonadherent behavior and find out what was really occurring. He was certainly not following the treatment plan, but it was not simply negativity. There was an unidentified problem beneath the surface that needed resolution before Michael could address his nonadherence. Family issues in this case study should not be overlooked. The wife and adult children should be included in discussions, with some focus on their own possible health issues, needs, and feelings as well. Further assessment and referral may be appropriate for the entire family. Because adherence to the treatment plan will be critical for a successful outcome for Michael, paying attention to family issues interfering with adherence is important. 2. Much of the time, the healthcare team is asking the patient to make significant changes in a lifelong pattern of behavior. This is not easy for anyone. Creating attainable short-term goals for which the patient can experience success is helpful in ultimately reaching long-term goals. The healthcare professional provides thorough and appropriate education and training on any aspect of the patient’s care plan to enhance cooperation with the recommended treatments and interventions. Use of the Internet or smart phone resources can help remind and educate the patient. Teaching family and friends to be alert for signs of changes in behavior is part of a holistic approach. Establishing a strong sense of rapport is essential to teaching being effective. It is also useful to discuss with the patient why adherence is difficult for them. Finding the root of the problem and addressing it directly can help with optimizing the patient’s ability to carry out the plan of care and achieve the desired health benefits. For example, the patient may not remember to take a prescribed medication because it is effectively working and there are no symptoms triggering the need to keep taking the drug. The healthcare professional can assist the patient with finding other reminders as to when the medication should be taken. Many people have cell phones equipped with alarm features, so teaching the patient how to use this alarm function may be a constructive way to gain adherence to medication use. Healthcare professionals who acknowledge their own problems make it less likely that those problems will interfere with helping the patient. Healthcare professionals, just like patients, may find it difficult to follow many health-related behaviors. Adherence on the healthcare professionals’ part helps patients see congruence in what is practiced by others and
CASE STUDY #2 (Continued)
The social worker remembered that Michael’s wife had bitterly discussed with her Michael’s lack of employment and his previous falls. The social worker admitted that she had focused on the wife’s hostility instead of on the possibility of an alcohol use disorder. She added that the behavioral habits of smoking and excessive coffee drinking have been linked in the literature to problem drinking. It was agreed that the social worker would meet again with Michael’s wife and discuss the possibility that Michael has an alcohol use disorder. With the information from that interview identifying Michael with a pattern of problem drinking, it was easier to approach Michael about his problem and he was, in fact, assessed and referred for treatment of an alcohol use disorder. Discussion Questions: 1. What are the staff’s issues regarding Michael’s nonadherence to his treatment plan? 2. What are some approaches that the healthcare professionals can use when caring for patients who are nonadherent? Discussion: 1. The evening staff healthcare professionals who described the patient’s wife as cold and mean were clearly angry. If they had examined their feelings closely, they might have discovered that they were angry with the patient for his unwillingness to participate in recovery. It is often easier to be angry at a healthy, and distant, family member than to be angry with the patient. It can be difficult for healthcare professionals to accept their anger toward a patient who is ill and with whom they interact on a daily basis. It seems like the night healthcare professionals felt little compassion for this patient. They were most likely dealing with feelings of powerlessness. Michael was a patient who ignored the rules and the healthcare advice offered to him. Powerlessness is difficult for anyone to experience and is most often masked by anger and rejection. When staff learn how to use techniques of brief assessment and intervention with patients who have alcohol problems and see their role in patient-centered care more clearly, they will feel less powerless. Most of the issues of nonadherence in this case study may be attributable to the patient’s unrecognized alcohol use disorder. Michael was unwilling to adhere to treatment recommendations because of his as-yet- untreated alcohol use disorder. His wanting to leave the hospital may be, in large part, motivated by his desire to have easier access to alcohol. If he had been discharged to home without treatment of this problem, his chances of a successful recovery would have been low. In addition, his alcohol use would
59
EliteLearning.com/Dental
Powered by FlippingBook