Non-compliance can be defined as "a failure to act in accordance with a wish or command; a failure to conform to rules or standards." But in healthcare we know this word has so much more meaning.
Non-compliance is a term that is oftentimes overheard or used to describe a patient's action or, better yet, non-action. Do we really know what we are saying and why? Do we seek to find out why a patient is non-compliant or do we readily accept and assume they are stubborn or unwilling? Do we investigate the reasons for non-compliance?
The World Health Organization refers to it as adherence (or lack thereof) to medication regimens and treatment. And over 50 percent of people over the age of 75 are found to be non-compliant with their medications.
Recently, in the hospital, I was approached by a frustrated nurse who was beyond her limit with a patient. This was in our oncology unit, and this patient had a long history of smoking and drinking alcohol. He was admitted for dehydration and was in the middle of his radiation treatment for his esophageal cancer.
This nurse was frustrated because the patient kept leaving the unit and she assumed that he was leaving the unit to go outside and smoke. She also added he often came back smelling of alcohol. When he left the unit, he would unplug his IV fluids without telling anyone. She asked us if we could just "send him home because he was being non-compliant." But I had to think. Was he really being non-compliant?
I asked her if he was eating and drinking fluids. "Like a horse," was her response. Aha! Good! We discontinued the IV fluids. And then I asked the nurse, "If we send him home, he may not be able to find transportation to make it to his last couple of radiation treatments. Do we know if he drives or has transportation?" Her response: "It doesn't matter! He won't show up anyway!" I just looked at her with a look of, "How do you know this?" with a raised eyebrow. She stopped, sighed loudly, and said, "Sorry. I have just had it with him!" So was he really being non-compliant? Or was the nurse just frustrated because he kept disappearing and making her day more difficult?
So, again, I ask, "What is being non-compliant?" When I discuss this topic with nursing students, I encourage them to find out the reason for non-compliance. Is the medication or treatment too expensive? Is there a transportation issue? Is the medication making the patient feel worse and not better? Is the patient just forgetful? Is the patient depressed?
There could be so many reasons for the non-compliance, I believe it is our responsibility to find out the reason and do what we can to resolve it or work with the patient to empower them to make better choices or actions that fit within their preferences and lifestyle.
What are your thoughts about non-compliance? Do you have any suggestions on approaching this topic with patients?