¶ … Compliance
Patient compliance is not always easy to obtain and it is frustrating when patients fail to follow recommendations and instructions. In addition, nurses and physicians tend to expect compliance while there is plenty of evidence derived from clinical studies that compliance should not be expected. This work intends to examine and analyze the issue of patient compliance. (Stone, et al., 1998) Lamb (nd ) reports that for products marketed in the United States "poor compliance with treatment regimens is estimated to cost the health care system around $100 billion each year. More than 100,000 patient deaths and one million hospital admissions each year, in addition to increased antibiotic resistance, are believed to be due to poor patient compliance in clinical trials is equally serious."
Stone et al. (1998) states that in the era of the empowered patient "it is time to think about compliance in a different way. Compliance implies an involuntary act of submission to authority, whereas adherence refers to a voluntary act of subscribing to a point-of-view." In fact, Stone et al. (1998) states that the difference "is not just semantic; it goes right to the heart of our relationship with our patients. We need to influence out patients to become -- or remain -- adherents of good self-care." According to one source it has been estimated by experts that "non-adherence costs the pharmaceutical industry in excess of $30 billion a year - not to mention, the chance at a fuller, healthier life for countless patients." (Eye For Pharma, 2010)
The work of Agnosta (2005) states that patient satisfaction with care received " is an essential criterion by which patients assess quality of medical care received. Positive satisfaction with health care is further viewed as a determinant of patient compliance and subsequent health status outcome." In fact the work of Renzi et al. (2001) is reported to have correlated "poor patient satisfaction with poor adherence to prescribed medical regimes and consequently poor health outcomes." (cited in Agnosta, 2005) In addition it is reported by Vuckovich that Graham (2002) states findings that "affective support, health information received, decisional control and technical competence all positively influenced client satisfaction with care." (nd)
Another aspect of patient compliance is the individual personality of the patient as according to Falvo (2004) "Patients differ remarkably in their perceptions of and reactions to what may appear to be similar medical conditions. Obviously, a variety of psychosocial factors determine individuals' reactions to illness, and, consequently, their reactions to the recommendations and advice given." (Falvo, 2004) Falvo relates that the individual who fails to adhere to a prescribed regimen oftentimes has reasons for this failure including economic reasons. Therefore, the nurse or physician should assess the reasons for failure to comply so that those reasons can be mitigated or alternative care options presented to the patient. (2004, paraphrased)
Purpose of Concept Analysis
The purpose of the concept analysis is to develop a conceptual definition of precisely what compliance means for the patient in terms of abiding by or adhering to their medical treatment plan. The concept of compliance is important for examination and definition in order to do away with any ambiguity concerning the concept and meaning of patient compliance. The work of Evangelista (1999) states that nurses "are challenged to embrace an interactive, transactional process in order to form a partnership with clients that enables and allows for client choice and control in decision-making about carrying out the prescribed behavior."
Why the Concept of Compliance is of Interest to Nursing
The role of the nurse in gaining the compliance of patients and maintaining the patient's compliance is a critical one. The work of Vuckovich (nd) states "Nursing ethical codes (ANA, 2001; Fowler, 2008; ISN, 2006) and standards of care (ANA, 2004) call for nurses to develop partnership models and empower patients." Hagenow wrote, of the influence of nurses on patient compliance stating:
"In its' positive sense power means to influence; influence means to get people to do something we want them to do because they want to. If we tell people what to do they'll comply. But if we get them to go there because they want to we have commitment" (1999, p.31)
The work of Ingram (2009) states that formal definitions of compliance:
"suggests a need for its reconceptualization in the nursing profession. As defined throughout literature, the term compliance suggests that patients are merely passive recipients of health care. Affording patients the opportunity to maintain autonomy by formulating care plans as a collaborative effort has proven highly effective in facilitating compliance."
Uses and Definitions of Compliance in Literature
1. Therapeutic alliance - a collaborative model in which the client's and family's voices are heard and their concerns addressed...
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