Improving Treatment Compliance

Nursing assessment throughout teaching aspects of patient care can improve compliance. The author shared strategies used in a children’s hospital. For example, ask the person to pretend she is explaining her health condition and needed care to a family member. This strategy identifies knowledge deficits.

Successful teaching to achieve compliance with the medical treatment plan also requires empathy - placing yourself in the patient’s position to personalize the care plan. For example, to set realistic goals for behavior change, ask the patient HOW the teaching will be applied at home - what will and what won’t work and why. From that a more realistic plan may be negotiated.

Make no assumptions about resources, skills, or support. Patients often give "expected" answers to questions with yes/no reply choices. Instead, format questions to gather descriptive information, e.g., "how often", "how do you manage to ….?". This will yield information about actual daily routines and challenges.

Minimize lecturing by getting the patient involved. For example, use scenarios to ask what he would do to follow medical orders in different situations. This strategy engages the patient in active problem solving. Before ending the encounter, ask the patient what he wants to know that hasn’t been discussed to identify unspoken concerns.

Finally, document assessments and teaching. Successful teaching as evidenced in patient behavior and resulting condition could demonstrate the cost-effectiveness of time spent in patient education.

(London F. Improving compliance: what you can do. RN 1998;1(1):43-46)

COMMENT: Some of us prefer terms other than "compliance" to set goals for individual health care plans, but the strategies are consistent with Judy Igoe’s (University of Colorado) Participatory and Assertive Consumer Training (PACT) education with school-age children. -J.O.