When clients ignore medical advice, fail to follow doctors orders or refuse to participate in recommended health improvement activities, they are said to be non-compliant. Do your nursing assistants know how to handle clients who cannot or will not adhere to their plan of care? Here is some basic information to keep your CNAs in the know.
What Does It Mean When a Client Is Non-Compliant?
Having a client who refuses to follow his or her treatment plan can be very frustrating. It can leave you feeling like you are doing a lot of work for nothing! Clients who fail to follow doctors orders are considered “non-compliant”, although this term is slowly being replaced by the term “non-adherence.”
Why? The dictionary defines non-compliance as “the failure to obey.” This term seems a little awkward for our modern society. Our goal is for clients to want to follow orders for their own well being… but they shouldn’t feel like they have to blindly obey in all circumstances!
Adherence, on the other hand, implies an agreement between the client and the medical team that the suggested treatments are valid, worthwhile and necessary for optimal health.
When you re-frame the problem of compliance into one of adherence, you will see that the solution lies in compromise, understanding and mutual agreement on a common goal.
However, until an agreement occurs, 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 non-compliance. This makes non-compliance the largest and most expensive “disease category”.
- In Europe, non-compliance causes nearly 200,000 deaths each year.
- One study found that “many people with chronic health conditions do not take their medications as often as prescribed − and that non-compliance may cost as much as $300 billion per year to the healthcare system.”
What About Patient Rights?
One of the most basic patient rights is the “right to participate”. This means that all patients/clients/residents have the right to:
- Make decisions about their own care.
- Change their minds about health care treatments and services.
- Refuse care (after being told what might happen if they do refuse).
- Have an advance directive if they want one, including a living will and/or health care power of attorney.
- Along with this right, patients have a responsibility to:
- Ask for more information if they don’t understand something.
- Go to all scheduled doctor appointments.
- Follow the plan of care that they help create.
- Provide your workplace with a copy of their living will or other advance directive.
- Allow your clients to refuse care if they wish-but be sure to document the situation and/or let your supervisor know.
- Keep in mind that a client‘s medical insurance may have rules about paying for care that the client keeps refusing. 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 allow you to assist with personal care.
- Honor any advance directive. For example, if your client has a “Do Not Resuscitate” order, made sure you know what to do if he or she stops breathing during your care.
- Make it a habit to explain what you are going to do with a client–before you do it. Your clients will be better prepared and more likely to comply if they know what’s going on. For example, explain to Mr. Wilson that you’re going to help him change position in bed-before you pull down his blanket and sheet!
- 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 home with no electricity. You might feel that Mr. Brown would be healthier if he could refrigerate his foods, but he has lived in his home for twenty years and sees no reason to change now.
- Never threaten your clients to get them to comply. For example, it’s wrong to say, “If you don’t take a bath right now, you can’t watch TV this afternoon.”
- Don’t force care on a client even if you know the client will be better off. For example, you can’t force a client to eat his lunch even if you are worried that he has been losing too much weight lately. (But be sure to document the fact that the client refuses to eat.)
Why Are Some Clients Non-Compliant?
There are many reasons your client may not follow a treatment plan. Sometimes, it is because of a combination of reasons. Here are a few of the most common causes for non-adherence to the plan of care:
Misunderstandings. Medical professionals speak their own language and can easily confuse non-medical people. Your client may not follow orders because the orders were not explained clearly or in a way that made sense.
Inability. At times, a treatment may simply be physically impossible for your client. To make matters worse, some clients may not be willing to admit they can’t 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 grief can cause the client to become too 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 may lead a client to be non-compliant. In addition, a negative past experience for a loved one can also influence a client to disregard or refuse medical advice.
Lack of Control. Needing to rely on others to complete life’s basic tasks can leave your client feeling vulnerable and helpless. Combine that helpless feeling with doctors and nurses who don’t always ask for the client‘s input on treatment. When clients feel they are not in control of their environment or treatment plan, they may not willingly participate.
Lack of Knowledge. Doctors and nurses have an obligation to explain diseases and their treatments to clients in a way that meets each individual’s needs. However, the information is not always communicated effectively. Language, cultural differences, stress and education level can all interfere with the client‘s understanding of a disease process.
Altered Mental Status. Clients with altered mental status may appear, at time, to be non-compliant. But, this situation is different for all the others as it is not considered willful non-compliance. In other words, the client is not necessarily responsible for deciding not to comply. This means that simply explaining the situation to the client won’t work!
No one wants to be ordered around or told what to do! Involving clients in the care plan will increase the likelihood of it actually succeeding!
All clients have rights. These include the right to be involved in their own care and the right to refuse treatment.
Change is hard! It’s not enough to just tell clients 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 running start by removing barriers to compliance, such as cost, access to health care and the 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 necessary to achieve optimal health!