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 compliant. Do your nursing assistants know how to handle clients who can’t or won’t adhere to your plan of care? Here is some basic information to keep your CNAs informed.

What does it mean when a client does not comply?

Having a client who refuses 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 doctors’ orders are considered “non-compliant”, although this term is slowly being replaced by the term “non-adherence”.
Why? The dictionary defines default as “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. obey in all circumstances!

Membership, 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 to one of adherence, you will see that the solution lies in compromise, understanding, and mutual agreement on a common goal.

However, until 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 noncompliance the largest and most expensive “disease category.”
• In Europe, non-compliance causes almost 200,000 deaths each year.
• One study found that “many people with chronic diseases do not take your medications as often as prescribed, and that non-compliance can cost the healthcare system up to $300 billion per year.

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 Correct a:

• Make decisions about your own care.
• Change your mind about health care treatments and services.
• Refuse care (after they have been 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 a:
• Ask for more information if you don’t understand something.
• Keep 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 go about your daily care, it’s important to balance the rights of your client with its desire to comply with the plan of care. Here are 7 tips for doing just that:

1. Allow your clients to decline care if they choose, but be sure to document the situation and/or report it to your supervisor.
2. Keep in mind that a client’s health insurance may have rules about paying for care that the client continues to refuse. 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.
3. Honor 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 their care.
4. Get used to explaining what you are going to do with a client.prior to 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.prior to you lower his blanket and his sheet!
5. 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 with no 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.
6. Never threaten your clients to make them comply. For example, it is wrong to say, “If you don’t take a shower right now, you won’t be able to watch TV this afternoon.”
7. Don’t force care of a client even if you know the client will be better off. For example, you can’t force a customer to eat lunch even if you’re concerned that he’s lost a lot of weight lately. (But be sure to document the fact that the customer refuses to eat.)

Why do some clients not comply?

There are many reasons why your client may not follow a treatment plan. Sometimes it’s for one combination of reasons These are some of the most common causes of noncompliance with the plan of care:

misunderstandings. Medical professionals speak their own language and can easily confuse non-doctors. Your customer 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 clients 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 very 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 non-compliance. 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 basic life tasks can leave your client feeling vulnerable and helpless. Combine that feeling of helplessness with doctors and nurses not always asking for a client’s input on treatment. When clients feel that they are not in control of their environment or treatment plan, they may not willingly participate.

Lack of knowledge. Physicians 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 level of education can interfere with a client’s understanding of the disease process.

altered mental status. Clients with an altered state of mind may appear non-compliant at times. But, this situation is different for all the others since it is not considered willful breach. In other words, the client is not necessarily responsible for deciding not to comply. This means that simply explaining the situation to the customer will not work!

Remember…

Nobody wants to be given orders or told what to do! Involving clients in the care plan will increase the likelihood that it will actually succeed!

All clients have rights. These include the right to participate in your own care and the right to refuse treatment.

Change is hard! It’s not enough to tell customers they have to make a change. They must be motivated to make the change in 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 needed to achieve optimal health.