How To Facilitate Better Patient Compliance Essay

REPLY 1

The best way to handle s situation and to aide Mrs. Faulkenberg’s compliance would be another health care professional apologizing to start. As a rule of thumb, I was taught when working with patients especially elderly Mr. and Mrs. Should be used when addressing them unless told otherwise (Mayne, 2019). If no-one responded when the name was called, then I feel the women should have been asked what her name is or if she is waiting to be seen. The approach just seems uncaring or professional. When calling names out into the waiting room I make sure to ask the patient if I pronounced their name right or if that is what they want to be called out of respect and the fact not everyone goes by their legal name. Making eye contact, a smile while introducing yourself is also important. If someone treated your grandmother like this how would you feel? How To Facilitate Better Patient Compliance Essay

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There are multiple things to consider as to why Alma Faulkenberger did not respond the way this situation played out. A full assessment should be completed before assuming, the patient also deserves specifics about herself to be asked in a private area. In this specific case I believe asking the patient what she would like to be called would be a great way to show respect and start forming a good patient-health care provider relationship. A bond must be established of trust before there will be a good working relationship. There is no way to even begin to know what this patient is dealing with or experiences she has had with healthcare providers simply approaching with empathy and attempting to listen to the patient can get you far. This patient could be hard of hearing, in pain, dealing with chronic conditions, or just flat out had bad experiences with providers. The other huge consideration could be the patient’s independence. The patient may feel hopeless or may have others making decisions for her and feels all she has left is her name and how dare someone take that. Elderly in general do not like to be told what to do or disrespected who would? I’ve personally had some patients that were resistant to everything just plan angry with life until they are allowed to make decisions and be apart of their care. These people are aging but they should be respected, and the best should still be provided no matter how difficult they are. Once these people see you care you can have a wonderful relationship it is rewarding for all parties. How To Facilitate Better Patient Compliance Essay

After an assessment should be a discussion of how the patient is feeling, and what questions she has about the procedure. Everything should be explained slowly. Medications should always be approached by educating the patient but allowing the patient to understand and actively decide whether those medications are a choice the patient wants. This will require a further understanding of the patient’s beliefs as well as goals. The entire patient must be considered. I would get to know the patient and discuss alternative options as well as medications. Then if the patient agrees I would provide education in person as well as with hand outs since it can be a lot of information to remember, small amounts of info at a time is less overwhelming.

Reference:

Farris, C. (2015). The teach back method. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=3126832

REPLY2

Alma Faulkenberger, an 85-year-old female outpatient who is seated in a waiting room awaiting an invasive pelvic procedure, has clearly become upset when the health care professional mis-pronounces her name several times. The health care professional further offends her be assuming that, due to her age and the fact that she did not answer to the mis-pronounced name, she must suffer from a hearing impairment. It is important in this instance to take extra care and consideration in ensuring that Alma is compliant with the procedure and post-treatment medications and receives effective patient education. This is necessary as frustrated patients can often become non-compliant, and Alma is clearly upset by the current situation. Furthermore, negative experiences within health care can impact a patient’s health outcomes as they may not seek medical assistance with necessary. How To Facilitate Better Patient Compliance Essay

According to the article How to Facilitate Better Patient Compliance, “several key factors are linked to non-compliance, including social and family relationships, experiences with the health care system and patient perceptions about illness and medication.” For this reason, considerations are necessary such as attempting to understand the patient’s perception of the situation. This includes acknowledging Alma’s feelings and addressing what has made her upset. This will address the issue at hand, thus, clarify any misunderstanding as well as change the negative tone of the encounter. A more positive tone will encourage compliance of the procedure.

A patient-centered approach should be implemented in order to develop an effective plan of care. This must include patient education in order to ensure compliance with post-treatment medications. Patient-centered approaches in health care highlight the partnership which exists between the patient and the health care professional (Falvo, 2011). Furthermore, this approach ensures that the patient is fully involved in the decision-making process and obtains any information related to their health and wellness. By being fully involved in this process, patients better understand plans of care, as well as medications and treatments. Patient-centered approaches in health care result in compliance and positive patient outcomes. Ultimately, “adherence is a reflection of good communication and a relationship that is built on respect, active participation, and partnership between patient and health professional” (Falvo, 2011). Thus, by addressing what has upset Alma, and implementing a patient-centered approach giving Alma a sense of understanding and control of her health, this will ensure an overall positive outcome is achieved. How To Facilitate Better Patient Compliance Essay

References:

Falvo, D. R. (2011). Effective Patient Education: A Guide to Increased Adherence. Retrieved from https://viewer.gcu.edu/RQBKXW

Rothenberg, G. (2003, June 03). How To Facilitate Better Patient Compliance. Retrieved fromhttps://www.podiatrytoday.com/article/1612

Medication compliance is a significant issue in the care of people with mental health conditions, particularly if the mental health condition is of an enduring and severe nature. The reason for this is that there is an increased likelihood of symptoms returning without the individual maintaining adherence to a prescribed medication regime. Conditions such as schizophrenia, psychosis and bi polar disorder fall under the remit of severe and enduring mental illness and it is reported that medication non compliance is likely to have severe implications to an individual’s psychological health and wellbeing (Le Page, 2010). How To Facilitate Better Patient Compliance Essay

Leahy (2006) estimates that up to 70% of recurrent depression patients and around one half of schizophrenia patients are noncompliant with their prescribed medication and there is also a direct relation between medication noncompliance and an increased need for hospitalisation. This in turn has a whole range of implications in terms of the impact this has on employment, relationships, income, and parental responsibility and of course the impact on resources provided by health providers such as the NHS should also be acknowledged.

This assignment will examine and reflect on the case of a 40 year old gentleman with a diagnosis of schizophrenia. The gentleman, who shall be referred to as Mr Smith for the purpose of this assignment (names have been changed to ensure client confidentiality as per NMC guidelines) has been receiving neuroleptic depot medication (Flupenthixol) to treat the symptoms of a schizophrenic condition, however Mr Smith has stated that he no longer was willing to accept the administration of the depot injection because he ‘felt better’. How To Facilitate Better Patient Compliance Essay

The assignment will start by briefly exploring the concept of compliance and the consequences of Mr Smith declining to take the prescribed medication and the potential impact this will have on his mental health. The second part of this assignment will reflect on how the practitioner responsible for the care of Mr Smith addressed the issue of facilitating the ongoing adherence to prescribed medication by focusing on theoretical frameworks that supported and encouraged Mr Smith to review his decision and continue to accept his depot injection. Consideration will also be made to legal and ethical frameworks that should be adopted in clinical practice when addressing the issue of medication compliance. How To Facilitate Better Patient Compliance Essay

Defining Compliance in Mental Health Care

The term compliance is defined by the Cambridge dictionary (2010) as being a process where people obey an order, rule or request and that individuals become willing to do what others want, particularly if the other person is a figure of authority. A core definition of compliance provided by Harvey (2004-09) suggests that compliance is the undertaking of activities or establishing practices or policies in accordance with the requirements or expectations of an external authority.

Compliance has been defined as the extent to which a person’s behaviour coincides with medical or health advice (Haynes, 1974) and although this is an outdated definition the term compliance persists in mental health care today. In contemporary mental health care there are suggestions that the term compliance has negative connotations and it infers that an individual who does not comply is not doing as they are ‘told’ by the mental health professional (Gray, 2002). Language and communication is an important tool in mental health and it is important to place the individual with mental health problems first by using terminology that is widely acceptable to both service providers and service users (Manzi, 2008). How To Facilitate Better Patient Compliance Essay

Repper & Perkins (1998) support this point of view and indicate that the use of words like compliance infers that patients are passive recipients of health care who should obey instructions from professionals. As modern mental health care is concerned with developing therapeutic alliances to improve outcomes (Hakan and Jan-Ake, 2010) consequently it has been proposed that the term concordance (Gray, 2002) or the phrase medication adherence (Velligan et al., 2009) should replace the use of the word compliance in an attempt to remove the unequal and passive tone the word compliance has.

For the purpose of this assignment the word compliance will be substituted by the term adherence as this implies a more collaborative approach between service providers and service users to approach the issue of medication and treatment. How To Facilitate Better Patient Compliance Essay

Consequences of Medication Non Adherence in Schizophrenia

Schizophrenia is a complex condition and diagnosis is made on the evidence of an individual’s reported experiences (symptoms) and observable behaviours (signs) which commonly may include; delusional thinking; hallucinations, thought interference; ideas of reference, thought disorder; social withdrawal; anxiety and depression (Keen, 2003). Psychiatric treatment for individuals almost always involves drug therapy to stabilise psychotic symptoms and to reduce the individual’s risk of relapse (Barker, 2003).

There are many different pharmacological preparations available for the treatment of symptoms experienced by an individual diagnosed with schizophrenia and they may include preparations that are taken orally or delivered by intramuscular depot injection. Our Client Mr Smith had been having a depot injection called Flupenthixol to treat the symptoms he experienced following his diagnosis of schizophrenia; as a result it is reported that he had felt better and therefore did not want to have the depot any more. How To Facilitate Better Patient Compliance Essay

Mr Smith had made a decision not to accept his depot medication any longer however it is well documented in the research and evidence base that this course of action and decision will have a significant impact on his health and global well being. Novick et al. (2010) indicates that non adherence with anti psychotic medications, such as Flupenthixol for patients with schizophrenia and psychosis, is significantly associated with an increased risk of relapse, hospitalization and suicide attempts. There is a significant body of evidence that highlights that the symptoms of schizophrenia return without pharmacological treatment and medication adherence and that there are potentially devastating consequences to the individual with a serious mental illness such as schizophrenia if this behaviour of non adherence is adopted (Velligan et al., 2010).How To Facilitate Better Patient Compliance Essay

Therapeutic Interventions to Promote Adherence

As a mental health practitioner it would not be uncommon at some point to experience a clinical interaction with a patient who has made a decision not to continue with their prescribed medication, however the practitioner has the responsibility to understand the reasons behind the patients decision making process and to provide the patient with the biggest opportunity to make an informed and educated decision about declining treatment for a chronic and enduring mental health condition such as schizophrenia.

It is important for the mental health practitioner to obtain an understanding of the reasons behind Mr Smith’s decision to discontinue his depot medication and to do this the modality of cognitive behavioural therapy can be implemented. Cognitive Behavioural Therapy (CBT) is a form of psychological therapy and aims to help understand the link between thoughts, emotions and behaviour. It teaches individuals skills to overcome problematic thoughts, emotions and behaviour and to find ways of overcoming negative thinking and challenging unhelpful and inaccurate thoughts or beliefs (Royal College of Psychiatrists, 2008). The most favourable outcome from CBT is for the individual to develop skills and techniques that enables them to approach situations in a more reasoned and balanced manner which supports problem solving and increases the feelings of being in more control (Royal College of Psychiatrists, 2008). How To Facilitate Better Patient Compliance Essay

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An important consideration in relation to implementing CBT and for that matter other therapeutic interventions is that there needs to be an established therapeutic relationship between the client and the mental health practitioner to increase the opportunity for success and for both parties to engage in working towards a common goal; for example for Mr Smith and the mental health practitioner to work towards exploring the issues surrounding medication adherence. NICE (2010) recommends that managing the process of engagement requires professionals to have sensitivity to the perspective of the individual and to understand that the condition can have a profound effect on the person’s judgment, their capacity to understand their situation and their capacity to consent to specific interventions. The process of engaging successfully with individuals with schizophrenia may at times require considerable persistence and flexibility from professionals and the establishment of trust is crucial. Both parties may have differing views on what the main problem is and how it should be addressed, however the professional can help with finding common ground and this common ground can establish trust and collaboration (NICE, 2010). How To Facilitate Better Patient Compliance Essay

To address the issue regarding Mr Smith’s decision to no longer adhere to his treatment plan and accept his depot medication for the symptoms of schizophrenia the mental health professional will need to enter into conversations to gain understanding of the patient’s perspective. One way of achieving this is for the mental health practitioner to adopt motivational interviewing so that the two parties can explore the decision (stopping of the depot injection) and negotiate behaviour change (acceptance of the depot) through the individual (Mr Smith) being able to identify, understand and articulate the benefits (remaining mentally well and symptom free) and costs involved (physical, emotional, family, employment for example will all be impacted upon greatly if symptoms return). How To Facilitate Better Patient Compliance Essay

Rollnick et al. (2010) indicate that simply giving patient’s advice to change decisions or behaviour is often unrewarding and ineffective and by adopting motivational interviewing a guiding style helps to engage with patients, helps clarify strengths and aspirations, evoke their own motivations for change and promote autonomy of decision making. The four central principles of motivational interviewing are described by Treasure (2004) as being; the use of reflective listening in an empathetic manner to convey understanding of the patients point of view; tease out ways the behaviour or choice conflicts with the wish to be good or viewed as good; respond with empathy and understanding rather that confrontation and finally support the patient in confidence building to understand change is possible. How To Facilitate Better Patient Compliance Essay

For Mr Smith and his decision to decline any further depot injections of Flupenthixol it may be very easy for the mental health practitioner and Mr Smith to become embroiled in conflict as the practitioner has the evidence base and clinical knowledge to know that a relapse is somewhat inevitable and the impact on Mr Smith’s global wellbeing and function would be significant; however Mr Smith believes that he is now well and therefore no longer needs treatment. By using motivational interviewing techniques the mental health practitioner can actively listen to Mr Smith’s reasoning behind the decision he has made in relation to medication adherence; support Mr Smith to see the pro’s and con’s of his decision; assess his confidence and elicit a view on his feelings fears and aspirations; exchange information; support with decision making and goal setting. How To Facilitate Better Patient Compliance Essay

To give an example of how motivational interviewing may be implemented the practitioner may ask questions such as;

‘I want to try and understand Mr Smith about your decision not to have your depot anymore; can you give me your perspective on why you want to stop taking it?’

‘So Mr Smith if you were to stop taking your depot, where do you think that would leave you in terms of remaining well?’

‘How important is taking this medication for you right now?’

‘Would you mind if I shared with you some information and evidence I have about how the depot injection helps people with schizophrenia remain well and symptom free?’ How To Facilitate Better Patient Compliance Essay

And;

‘Okay, can I check with you your understanding of the risks of not accepting the depot anymore?’

This approach to supporting adherence to medication is reported to be beneficial and it is suggested that the body of evidence continues to grow in support of its effectiveness (Rollnick et al., 2010) and with the many applications in psychiatry it is particularly helpful for use in settings where there is resistance to change (Treasure, 2004). However there are some considerations that need to be identified that may impact on the efficacy of motivational interviewing as a technique to support medication adherence. Firstly one issue to consider is that motivational interviewing is a skill that mental health practitioners need to develop and practice and although the principles are described as easy (Treasure, 2004) putting these principles into practice may not be that simple. How To Facilitate Better Patient Compliance Essay

There potentially could be many different variables as to why adopting motivational interviewing may not be effective in supporting medication adherence. Barriers that may impact on the success of motivational interviewing in supporting Mr Smith to maintain his medication adherence may include; there not being a therapeutic alliance established between the mental health practitioner and Mr Smith. The reasons for this can be numerous, for example Mr Smith may only recently have been discharged from hospital and the mental health practitioner is his new community psychiatric nurse that he has only met a couple of times; Mr Smith may prefer male workers to female workers and vice versa or even Mr Smith may not feel comfortable having mental health practitioners come to his home and feel unable to engage or discuss issues of importance. Another reason that may impact on the efficacy of the motivational interviewing process to support Mr Smith’s adherence to medication is that the mental health practitioner may be constrained by time and resources and therefore not able to deliver the therapeutic process accurately or in a timely. How To Facilitate Better Patient Compliance Essay

Another issue to consider is that Mr Smith’s adherence to medication and decision not to continue to accept the depot may actually be based on the schizophrenic condition relapsing and the decision to withdraw from treatment is being made due to reduced insight and understanding. It is suggested that there are potentially a large range of risk factors that can be present and that are related to the patient’s individual behaviour and understanding of the impact of schizophrenia and psychosis. These variables are classified as patient related and include poor insight, negative attitude towards medication, symptom severity, history of previous non adherence, substance misuse and cognitive impairment. Other variables may also include treatment, environmental and societal issues such as side effects and complexity of medication regimes’ family support, side effects, financial problems and lack of access to treatment (Citrome, 2010). How To Facilitate Better Patient Compliance Essay

Legal and Ethical Considerations

It is important for mental health practitioners to understand that there are occasions where more assertive and restrictive approaches such as treatment orders or inpatient hospital care are the only way for adherence to medication to be sustained (Chaplin, 2007). The Mental Capacity Act (2005) provides a framework for the making of decisions for people who lack capacity in England and Wales. Under the Capacity Act healthcare professionals are advised that they must work on the presumption that every adult patient has the capacity to make decisions about their care, and to decide whether to agree to, or refuse, an examination, and investigation or in this instance treatment. A patient is regarded as lacking capacity once it is clear that, having been given all appropriate help and support, they cannot understand, retain, use or weigh-up the information needed to make that decision, or communicate their wishes.How To Facilitate Better Patient Compliance Essay

Therefore in this instance Mr Smith must be presumed to have capacity to make the decision not to adhere to the treatment plan unless there is evidence that he is no longer able to provide reasoned information to support his decision due to the presence of severe mental illness. It would be at this juncture that the mental health practitioner would look to ensuring Mr Smith’s best interests are explored and this may result in an assessment under the Mental Health Act (1983), however until this time the mental health practitioner may continue to use the therapeutic alliance and CBT and motivational interviewing techniques to support the adherence process. How To Facilitate Better Patient Compliance Essay

The success of a therapeutic alliance is often based on trust and to establish trust the mental health practitioner must respect the patient’s ethical right to autonomy. Autonomy for Mr Smith would be the right to decide and determine whether or not to accept or decline his depot injection even if the refusal meant that his mental health would deteriorate and the consequences to his global wellbeing become severely impaired. It would be unethical for the mental health practitioner to coerce, threaten or manipulate Mr Smith into having the depot injection particularly if he has the mental capacity to make the decision to decline further treatment. For the mental health practitioner to behave in this manner would not only be a breach of professional and ethical conduct it would also potentially jeopardize any therapeutic alliance that had been developed. How To Facilitate Better Patient Compliance Essay

Addressing Risk

Mr Smith’s decision to become non adherent to prescribed medication presents a requirement for detailed risk planning and assessment to ensure the well being of Mr Smith, his family and friends and those providing care to him is sustained. Mental health practitioners have a duty of care to assess risk using a formulated tool that has been adopted by their employer and mental health service. The calculation of risk must be based on the practitioners knowledge, skills and competence and value should be placed on the process of risk taking, following assessment and in the context of appropriate management, as it will increase the practitioner’s ability to help clients to achieve their potential. However, there should be awareness that there may be conflicts between professional accountability and the autonomy of the client (UKCC, 1998). How To Facilitate Better Patient Compliance Essay

Risk issues that may be identified for Mr Smith are individual and related to the course and nature of his experience of Schizophrenia, this is why it is important for the practitioner to have established a therapeutic alliance with him so that discussions can be held about risk issues and care planning can be done collaboratively to reduce the risk impact.

Conclusion

Medication adherence in schizophrenia is a complex issue with the consequences of non adherence impacting significantly on the global function and mental well being of individuals who make the decision to not adhere to their medication treatment plan. Through the process of collaboration and the development of therapeutic alliances between mental health professionals and patients it is suggested that adherence can be improved and sustained and that interventions such as CBT and motivational interviewing makes psychoeducation a cornerstone of many adherence interventions (Zygmunt et al., 2002). How To Facilitate Better Patient Compliance Essay

Mental health practitioners should have an understanding that medication adherence is less likely to occur in patients with severe mental illness who are not engaged with mental health services and who are not exposed to a good therapeutic relationship. One of the most common themes that have been identified throughout this assignment and in the evidence base is that the therapeutic alliance between a patient and mental health professional should never be underestimated particularly when it comes to supporting medication adherence in the treatment of schizophrenia.

Adherence to Medical Advice a) Adherence to medical advice depends on various factors. Psychologists have carried out research and experiments to find the factors into compliance. Kent and Dalgleish (1996) had claimed that perceived seriousness of illness of the mother was more important than that of the doctors, this meant that mothers who felt their children were more susceptible to illness were more likely to adhere to a medical regime set out by the doctor, and attend the appointments made than those mothers who had a different conviction. The study of Turk and Meinchenbaum (1991) supports the idea that patients are less likely to adhere due to the potential side effects of…show more content…
Payne and Walker (1996) advocated the fact that patients who have a low self-esteem are more likely to value what the doctor tells them and thus as a result more likely to adhere as a doctor in their perspective is a person of high esteem. The older you get the more likely you are to forget what the doctor has said, Yung et al (1998) showed that age can have an affect on adherence rates, thuss the older people have more difficulty in recalling information related to their medical conditions and the associated treatmeant required. How To Facilitate Better Patient Compliance Essay

Giving people the opportunity to raise concerns about medication is also important. This is consistent with research on the determinants of adherence which tells us that patients typically only follow recommendations they really believe in and those they actually have the ability to carry out.3 While many people, particularly parents of young children, may be concerned about possible side effects of medication, it is equally important to reinforce the possible risks of not taking medication. Providing opportunities for discussion and choice about medication type and delivery device is a strategy to encourage greater involvement in asthma self-management and improve adherence. How To Facilitate Better Patient Compliance Essay