The term compliance is defined as the act of affirming, obeying, acquiescing, or yielding. The patient is passively abide by the advice and yield to the health care professional. It has a dictatorial connotation. The patient abides by the goals of the health professional. In contrast, the terms adherence and collaboration are used to describe implied that patients have more autonomy and independent in following their treatment planning. Adherence is based on patient-centered model; through research, it has shown to promote patient satisfaction and health outcomes.
In order to increase adherence, the health care provide needs to educate the patient. The patient needs to be informed about their condition, risks, benefits and treatment. Communication plays a major role in promoting adherence. If the information is conveyed clearly and completely enough the patient may be compelled to follow. Effective communication will help to foster trust and rapport. Poor communication skills and non-adherence are related. If the patients do not understand about their condition or treatment, then they do not enough knowledge to make decisions or follow recommendations.
If the nurse shows lack of compassion and empathy, this will discourage patients from opening up and lead to non-adherence. The root of adherence is effective education through communication. The health care provider needs assess the patient’s learning needs. Collaboration means the health care professional need to involve the patient in decision making and problem solving. He needs to involve the patient in the planning and goals setting. This has been proven to improve adherence and thus positive patient outcomes.
Previously, health care and education is based on paternalism, patients had insufficient access to information. Patients had limited partnership in decision making. Health care providers decided what information was to be given to the patients. The quantity and type of information given to patients was frequently insufficient. The information that was presented to the patient was disorganized and evaluation as to whether the patients understood the information was limited. This approach has been changed now. Social and political factors as well as technological advancement have lead to this change.
According to the Patient’s Bill of Rights, the patients are in charge of their health care. The patient has the right to receive information in understandable terms to that they can make informed choices about their health. The nurse should take every opportunity to teach the patient. The education should be tailored to the patient specific needs. Each encounter allows the health professionals with opportunity to build trust and rapport. The professional needs to learn how to effectively educate the patient so that they incorporate the recommendation into their daily life.
The key to effective education is to educate, empower, and support. Professionalism and empathy from the health care professional also play a key role The three categories of learning are cognitive, psychomotor, and affective domains. The cognitive domain includes content knowledge and development of intellectual skills. This includes the recall or recognition of specific facts and concepts. In psychomotor domain, it requires practice and the use of motor skills. In affective domain, it includes feelings, motivations and attitudes.
All of these domains play a key role in affecting the ability to learn and carry out recommendations by the health care professional. An example that includes all these learning domains would be the case of Mr. Smith. This patient is obese and needs to lose thirty pounds. The dietitian and Mr. Smith sat down together and develop a teaching plan and goals. At the end of the teaching program, Mr. Smith was able to describe the health benefits of a low fat diet (cognitive). Mr. Smith was able to use the food labels and calculate the calories from each serving (psychomotor).
Mr. Smith will be asked whether he has any questions about the material being taught (affective). Patient motivation is impacted by intrinsic and extrinsic factors. At times, intrinsic constituents can negatively influence a patient’s motivation for learning and adherence. Anxiety, apprehension, and lack of self confidence are intrinsic factors. Extrinsic factors can also influence the patient’s motivation to learn. An example of extrinsic factor that negatively affects motivation is the case of Mrs. Mason. Mrs. Mason suffers from a stroke.
She was progressing well from the rehab facility and was discharged. At home, her daughter insists on feeding her and prevents from doing daily activity on her own. Mrs. Mason becomes more dependence and forgoes most of the strategies that she learned at the rehab facility. Unless the health care provider recognizes these factors and apply appropriate interventions, the patient’s motivation for following recommendation will be limited. Patients with low self-efficacy believe that they cannot be successful and may consider challenging tasks as threats.
In order to assist patients to develop self-efficacy, the health care providers should consistently recognize and praise on patients’ accomplishments. Documentation is a crucial part of patient teaching. Documentation allows the health care professionals to evaluate the effectiveness of patient education. It prevents fragmentation and facilitates continuity of care. The health care professional needs to identify the patient’s responses, strengths, and barriers. In addition, alternative strategies to overcome barriers need to be documented.