Noncompliance, also known as nonadherence, is a significant challenge in healthcare that can greatly impact patient outcomes. Noncompliance nursing diagnosis refers to a patient’s inability or unwillingness to follow a prescribed treatment plan or adhere to health-related recommendations.
This article provides a detailed exploration of the noncompliance nursing diagnosis, including its causes, signs and symptoms, expected outcomes, nursing assessment, interventions, and care plans.
Causes (Related to)
The following are common causes of noncompliance:
- Lack of understanding or knowledge about the condition or treatment
- Financial constraints or lack of insurance coverage
- Complex treatment regimens
- Side effects of medications or treatments
- Cultural or religious beliefs conflicting with treatment plans
- Mistrust in healthcare providers or the healthcare system
- Cognitive impairments or mental health issues
- Lack of social support or transportation
- Health literacy barriers
- Denial or minimization of the health condition
- Substance abuse or addiction
- Previous negative experiences with healthcare
Signs and Symptoms (As evidenced by)
Subjective (Patient reports):
- Expressing disinterest in or disagreement with the treatment plan
- Voicing concerns about medication side effects or treatment efficacy
- Reporting financial difficulties in obtaining medications or treatments
- Expressing cultural or religious conflicts with prescribed treatments
Objective (Nurse assesses):
- Missed or frequently rescheduled appointments
- Failure to fill or refill prescriptions
- Worsening health condition or lack of improvement
- Inconsistent or inaccurate medication administration
- Laboratory results indicating non-adherence (e.g., subtherapeutic drug levels)
- Repeated hospitalizations or emergency department visits for preventable complications
Expected Outcomes
- The patient will demonstrate increased adherence to the prescribed treatment plan.
- The patient will verbalize understanding of their condition and the importance of treatment adherence.
- The patient will actively participate in shared decision-making regarding their care.
- The patient will identify and utilize resources to overcome barriers to adherence.
- The patient will show improvement in health status indicators related to increased compliance.
Nursing Assessment
Evaluate the patient’s understanding of their condition and treatment plan:
- Assess health literacy and provide education at an appropriate level
- Identify any misconceptions or knowledge gaps
Explore the patient’s beliefs, values, and cultural practices:
- Determine if there are any conflicts between the treatment plan and the patient’s belief system
- Assess for any cultural barriers to adherence
Assess for potential barriers to adherence:
- Financial constraints
- Transportation issues
- Lack of social support
- Cognitive impairments
- Language barriers
Review the patient’s medication regimen:
- Assess for complexity, side effects, and potential drug interactions
- Evaluate the patient’s ability to manage their medications independently
Nursing Interventions
Provide patient-centered education:
- Use teach-back methods to ensure understanding
- Offer information in various formats (verbal, written, visual) to accommodate different learning styles
Simplify the treatment regimen when possible:
- Collaborate with the healthcare team to streamline medication schedules
- Explore options for combination medications or extended-release formulations
Address barriers to adherence:
- Connect patients with social services or financial assistance programs
- Arrange for transportation or home health services if needed
- Provide medication organizers or reminders to aid with adherence
Foster a strong patient-provider relationship:
- Practice active listening and empathy
- Involve the patient in shared decision-making
- Address any concerns or mistrust openly and honestly
Implement motivational interviewing techniques:
- Help patients identify their own reasons for wanting to improve their health
- Encourage self-efficacy and reinforce positive behaviors
Utilize technology to support adherence:
- Recommend medication reminder apps or smart pill dispensers
- Explore telehealth options for follow-up appointments
Collaborate with a multidisciplinary team:
- Involve pharmacists in medication education and regimen simplification
- Consult with social workers or case managers to address socioeconomic barriers
- Engage mental health professionals if psychological factors contribute to noncompliance
Nursing Care Plans
Here are five nursing care plans addressing different aspects of the noncompliance nursing diagnosis:
Nursing Care Plan 1: Knowledge Deficit
Nursing Diagnosis Statement:
Deficient Knowledge related to lack of information about the disease process and treatment plan as evidenced by verbalization of misconceptions and failure to follow the prescribed regimen.
Related factors/causes:
- Limited health literacy
- Cognitive impairments
- Language barriers
- Inadequate patient education
Nursing Interventions and Rationales:
- Assess the patient’s current knowledge level and learning style.
Rationale: Tailoring education to the patient’s preferred learning method enhances comprehension and retention. - Provide education using simple language and visual aids.
Rationale: Clear, accessible information improves understanding and promotes adherence. - Use the teach-back method to verify comprehension.
Rationale: This technique allows the nurse to identify and address any misunderstandings immediately. - Offer written materials in the patient’s preferred language.
Rationale: Providing information in the patient’s native language ensures better understanding and recall.
Desired Outcomes:
- The patient will demonstrate an accurate understanding of their condition and treatment plan.
- The patient will verbalize the importance of adherence to the prescribed regimen.
- The patient will show improved compliance with treatment recommendations.
Nursing Care Plan 2: Ineffective Health Management
Nursing Diagnosis Statement:
Ineffective Health Management related to the complexity of the therapeutic regimen as evidenced by verbalization of difficulty following a treatment plan and missed medication doses.
Related factors/causes:
- Complex medication schedule
- Multiple healthcare providers
- Overwhelming amount of health information
- Lack of organizational skills
Nursing Interventions and Rationales:
- Collaborate with the healthcare team to simplify the treatment regimen when possible.
Rationale: A simplified regimen is easier for patients to follow and increases adherence. - Teach the patient how to use a medication organizer or reminder system.
Rationale: Organizational tools can help patients manage complex medication schedules more effectively. - Assist the patient in creating a daily routine that incorporates their treatment plan.
Rationale: Integrating health management into daily life promotes consistency and adherence. - Provide clear, written instructions for all aspects of the treatment plan.
Rationale: Written instructions are a reliable reference for patients to review independently.
Desired Outcomes:
- The patient will demonstrate the ability to manage their treatment regimen independently.
- The patient will report consistent adherence to prescribed medications and treatments.
- Patients will show improvement in health status indicators related to effective health management.
Nursing Care Plan 3: Decisional Conflict
Nursing Diagnosis Statement:
Decisional Conflict related to perceived risks/side effects of treatment as evidenced by verbalized uncertainty about treatment choices and delay in treatment initiation.
Related factors/causes:
- Fear of medication side effects
- Conflicting information from various sources
- Lack of trust in healthcare providers
- Personal values conflicting with treatment options
Nursing Interventions and Rationales:
- Provide comprehensive information about treatment options, including risks and benefits.
Rationale: Accurate information helps patients make informed decisions about their care. - Use decision aids to help the patient weigh the pros and cons of different options.
Rationale: Visual tools can clarify choices and facilitate decision-making. - Encourage the patient to express their concerns and values regarding treatment.
Rationale: Acknowledging patient perspectives promotes trust and shared decision-making. - If appropriate, arrange for the patient to speak with others who have undergone similar treatments.
Rationale: Peer support can provide real-world insights and alleviate fears about treatment.
Desired Outcomes:
- The patient will verbalize increased comfort with treatment decisions.
- The patient will actively participate in shared decision-making with the healthcare team.
- The patient will initiate an agreed-upon treatment plan within a mutually established timeframe.
Nursing Care Plan 4: Ineffective Coping
Nursing Diagnosis Statement:
Ineffective Coping related to psychological distress as evidenced by verbalization of feeling overwhelmed and inability to adhere to treatment recommendations.
Related factors/causes:
- Depression or anxiety
- Lack of social support
- Unresolved grief or loss
- Substance abuse
Nursing Interventions and Rationales:
- Assess for signs of depression, anxiety, or other mental health issues.
Rationale: Mental health problems can significantly impact a patient’s ability to manage their health effectively. - Provide emotional support and active listening.
Rationale: A supportive environment can help patients feel more capable of managing their health challenges. - Teach stress management and coping techniques.
Rationale: Effective coping skills can improve overall well-being and capacity for self-care. - Refer to mental health professionals or support groups as appropriate.
Rationale: Specialized support can address underlying psychological issues affecting adherence.
Desired Outcomes:
- The patient will demonstrate the use of effective coping strategies.
- The patient will report decreased feelings of being overwhelmed by their health condition.
- The patient will show improved adherence to the treatment plan as psychological distress decreases.
Nursing Care Plan 5: Spiritual Distress
Nursing Diagnosis Statement:
Spiritual Distress related to conflict between treatment plan and spiritual beliefs as evidenced by verbalized concerns about violating religious practices and refusal of certain treatments.
Related factors/causes:
- Religious or spiritual beliefs conflicting with medical recommendations
- Lack of accommodation for spiritual practices in the healthcare setting
- Feeling disconnected from sources of spiritual support
- Fear of judgment from healthcare providers regarding spiritual beliefs
Nursing Interventions and Rationales:
- Assess the patient’s spiritual beliefs and practices.
Rationale: Understanding the patient’s spiritual background allows for more culturally competent care. - Explore how spiritual beliefs impact the patient’s health decisions.
Rationale: This helps identify specific areas of conflict between treatment and spiritual practices. - Consult with spiritual leaders or chaplains as appropriate.
Rationale: Spiritual advisors can help reconcile medical treatments with religious beliefs. - Advocate for the accommodation of spiritual practices within the treatment plan when possible.
Rationale: Integrating spiritual practices into care can improve patient comfort and adherence.
Desired Outcomes:
- The patient will express decreased spiritual distress related to the treatment plan.
- The patient will identify ways to maintain spiritual practices while adhering to medical recommendations.
- The patient will demonstrate improved compliance with the treatment plan without compromising spiritual beliefs.
Conclusion
Addressing noncompliance in nursing care requires a comprehensive, patient-centered approach. By understanding the multifaceted causes of noncompliance and implementing targeted interventions, nurses can play a crucial role in improving patient adherence and overall health outcomes. The nursing care plans offer a framework for addressing various aspects of noncompliance, from knowledge deficits to spiritual concerns. Remember that each patient is unique, and interventions should be tailored to individual needs and circumstances.
References
- Butcher, H. K., Bulechek, G. M., Dochterman, J. M., & Wagner, C. M. (2018). Nursing Interventions Classification (NIC) (7th ed.). Elsevier.
- Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions and Classification 2018-2020 (11th ed.). Thieme.
- Moorhead, S., Swanson, E., Johnson, M., & Maas, M. L. (2018). Nursing Outcomes Classification (NOC): Measurement of Health Outcomes (6th ed.). Elsevier.
- Orem, D. E., Taylor, S. G., & Renpenning, K. M. (2001). Nursing: Concepts of Practice (6th ed.). Mosby.
- Registered Nurses’ Association of Ontario. (2016). Clinical Best Practice Guidelines: Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients. RNAO.
- World Health Organization. (2003). Adherence to Long-Term Therapies: Evidence for Action. WHO.
