Noncompliance Nursing Diagnosis and Nursing Care Plans

Noncompliance Nursing Care Plans Diagnosis and Interventions

Noncompliance NCLEX Review and Nursing Care Plans

Noncompliance is a NANDA nursing diagnosis described as the behavior of a patient and caregiver that does not correspond with the therapeutic plan agreed upon by the individual, family or guardian, and healthcare practitioner.

Medication, treatments, follow-up appointments, and lifestyle changes are examples of this. It is also vital to highlight that noncompliance has a negative perception because it refers to a clinician deciding on an appropriate therapy assuming that the patient will cooperate.

The majority of healthcare noncompliance challenges include the safety of patients, patient data privacy, and billing procedures.

Moreover, nonadherence to healthcare guidelines, prescriptions, and treatments is related to poorer results, reduced quality of life, and increased healthcare expenses.

Failure to comply has a cascading impact also on the quality of treatment provided to the patients. When inefficient processes and procedures are followed, it leads to a rise in patient care difficulties.

If the hospital fails to meet norms and regulations, the patients will suffer. On the other hand, nurses can play an essential role in identifying noncompliance and collaborating with patients to achieve meaningful goals.

Furthermore, patient education has enhanced drug adherence across various disorders and disease severity. Patient knowledge, on the other hand, does not guarantee compliance.

A patient must be well equipped and well educated about their disease’s management, doctor recommendations, and potential adverse effects of any therapies.

The more precisely a condition is recognized, the more probable it is that a person may become complacent with their treatment and adhere to suitable intervention regimens.

Signs and Symptoms of Noncompliance

Noncompliance might occur due to the patient misinterpreting guidelines, disregarding, or just ignoring advice. Other patients may make a well-informed decision to refuse specific treatments.

The following are common indications of patient noncompliance:

  • Failure to maintain scheduled follow-up appointments
  • Inability to carry out suggested screening procedures or laboratory tests
  • Noncompliance with consultation guidelines
  • Difficulty to adhere to drug directions and monitoring schedules
  • Inability to change one’s habits and lifestyle such as alcohol, diet, exercise, smoking, and weight loss
  • Expressions of dissatisfaction, suspicion, or refusal

Causes of Noncompliance

  1. Inadequate doctor-patient relationship. Physicians do not have much time with patients; therefore, they must make the consultation worthwhile. The healthcare provider must provide a transparent and detailed discussion regarding treatment compliance.
  1. Forgetfulness. Patients have hectic schedules and may forget to take their medications on occasion. Others may have cognitive limitations or mental conditions that make drug adherence difficult.
  1. The patient’s lack of comprehension. Noncompliance is common when patients do not comprehend why they are taking a particular drug. Assist them with comprehending the medication’s goal and why and how this will benefit them. Describe any probable adverse effects as well.
  1. Biases based on culture or religion Medication adherence is lower in less culturally assimilated patients. Similarly, some people may refuse to take their prescription due to a strange religious doctrine.
  1. Cost. As the price of prescription medications keeps rising with no end in sight, it is not unexpected that many people fail to take them because they merely cannot afford them.
  1. Physical disabilities. A patient’s physical disabilities can also cause medication noncompliance. A patient, for instance, may have a vision impairment that limits his ability to comprehend printed instructions. Another patient may have a hearing problem that makes it difficult for her to understand the doctor’s verbal commands for taking the medication.
  1. Lack of access to transportation. According to research, transportation impediments impact access to pharmacies and thus treatment adherence.

Related Factors to Noncompliance

  • Age, race, sexuality, education, and marital status
  • Beliefs, motivation, and attitude are examples of psychosocial influences.
  • Patient-prescriber connection
  • Literacy in health.
  • Patient understanding.
  • Physical impairments
  • Tobacco or alcohol consumption.
  • Forgetfulness.
  • Cognitive impairment, including memory and attention abilities, and psychological problems such as anxiety and depression, are possible related factors.
  • Differences in personal health evaluations and motivation to continue with treatment
  • The purpose of therapy
  • The treatment plan’s complexity
  • Unhealthy and stressful lifestyle
  • Inadequate financial resources
  • Impaired emotional state
  • History of noncompliance in the past

Nursing Considerations for Noncompliant Patients

  1. Exercise compassion and empathy. The nurse must put herself in the patient’s shoes and make every effort to be empathic, realizing the difficulties they may face when interpreting patients’ requests. When circumstances feel out of control, healthy breathing methods might help the nurse keep her sanity and professionalism.
  2. Educate. As a consideration for the patient’s noncompliance, the nurse must educate the patient because the patient may exhibit noncompliant behaviors merely since they do not grasp the diagnostic or treatment recommendations.
  3. Keep up with documentation. While keeping careful records is already part of the routine, it is especially vital when coping with noncompliant patients.
  4. Set and enforce boundaries. Noncompliant behavior might occur when a patient is persistent or tends to test how far they can push their nurses’ limits.  As a health professional, always be determined to stick to the limits set, which is in the best interests of the nurse and the patient’s as well.
  5. Avoid using ultimatums. Do not frighten a disobedient patient with empty ultimatums; instead, be fair while discussing their options. Maintain the focus on the benefits of compliance, which may help obtain well-deserved trust and credibility. Avoid power struggles by explaining different scenarios and repercussions, but always give the patient the option to choose.

Noncompliance Nursing Diagnosis

Noncompliance Nursing Care Plan 1

Seizure Disorder

Nursing Diagnosis: Noncompliance related to financial constraint, denial of the illness, and the therapeutic regimen’s perceived negative implications secondary to seizure disorder as evidenced by behavior indicating noncompliance with therapy recommendations, the emergence of complications, and aggravation of symptoms.

Desired Outcome: The patient will express his awareness of the illness and therapeutic regimen and comprehend the negative consequences of continuing nonadherent actions.

Noncompliance Nursing InterventionsRationale
Examine the patient’s understanding of seizures, medical management, and therapy options.  This intervention enables nurses to discuss or reinforce information as needed, facilitating a customized treatment plan promoting compliance.    
Explain how to cope with various nonadherence factors such as financial limits and workplace discrimination.    It is critical to remove and overcome these hurdles to comply with the treatment regimen.
Discuss and dispel misconceptions and stereotypes. Provide a comprehensive risk assessment and correct any misunderstandings.    This method will aid in the identification of elements that may influence compliance, such as culture, religious belief, or personal perception.  
Educate the patient about the following:

A consistent blood level and a medication’s half-life.

Instructions for missing doses

How to refill a prescription if the medication has been misplaced or depleted.

Timetable for laboratory follow-up.The significance of contacting the health care provider if the drug is abruptly discontinued.  
Intermittent pharmaceutical use may be an attempt to regain control. Acknowledging the implications of nonadherence raises awareness of the situation that discontinuing anti-seizure drugs can result in severe and fatal complications.    
Assist the patient in locating accessible support networks, such as local epilepsy centers and epilepsy-specific organizations.  Patients may be able to comprehend better and feel supported by the experiences of others who have the same condition.  
Discuss the potential of changing the therapy plan with the health care physician to the patient once the reasons for nonadherence have been discovered. Guide the patient on how to manage the adverse effects of anti-seizure drugs:

Avoiding alcohol to avoid additional sedative effects

To reduce gastric disturbance, take medication with food.  
Compliance is encouraged by these approaches.    
If needed, recommend psychotherapy or counseling.  Improves the quality of life and emotional well-being of patients suffering from disease, which may cause noncompliance.    
Examine the causes of noncompliance, such as a history of noncompliance, socioeconomic background, forgetfulness, pharmaceutical side effects, uncertainty about prescription recommendations, or difficulties implementing significant lifestyle adjustments.Identifying these causes allows the nurse to concentrate on the patient’s care plan and take necessary steps.
Allow the patient to express apathy, hopelessness, powerlessness, and disgrace. Examine the patient’s perception of the efficacy or inefficacy of the prescribed treatment.  This intervention allows the nurses to shed light on the patient’s perception of vulnerability to the disease process and indicators of illness denial.  
Examine the patient’s support system.  This method aids in determining whether a problem in the family pattern influences the patient’s noncompliance.    

Noncompliance Nursing Care Plan 2

Conduct Disorder

Nursing Diagnosis: Noncompliance related to resentment of those in positions of authority secondary to conduct disorder as evidenced by causing harm to individuals or causing property damage.

Desired Outcome: The patient will not cause harm to individuals or destruction to property and will take active participation in the treatment.

Noncompliance Nursing InterventionsRationale
Reduce violence and boost adherence to therapy.    At the start of therapy, the nurse must place boundaries on improper behavior; for limit setting to be efficient, the implications must have significance for the clients—that is, the patient must respect or seek leisure time.
Improve the patient’s coping abilities and self-esteem.  The nurse must recognize patients as valuable people even if their conduct is inappropriate; the nurse must be firm in imposing restrictions and refrain from making judgmental statements about the patients.    
Encourage social engagement. .  The nurse determines what is inappropriate, such as swearing and name-calling, and what is suitable; constructive feedback is crucial to ensure patients are functioning as expected
Encourage patient-family interaction  The nurse can educate parents about age-appropriate routines and expectations for their patients, such as realistic curfews, household tasks, and appropriate home behavior.    
Help the patient divert his attention if he starts to behave furiously or aggressively toward other people or property.  This intervention will assist the patient in exercising self-control so that he does not injure others or destroy property.    

Noncompliance Nursing Care Plan 3

Angina Pectoris

Nursing Diagnosis: Noncompliance related to refusal to accept essential lifestyle adjustments secondary to angina pectoris as evidenced by lack of understanding about the possible severe complications of the condition.

Desired Outcome: The patient will comprehend the relevance of lifestyle changes in managing angina pectoris, the illness process, and the importance of adhering to prescribed care.

Noncompliance Nursing InterventionsRationale
Evaluate and record patient compliance to medication.    The rationale is that it provides details concerning the progression of the disease. It also aids in determining the efficacy of therapies and may signal the necessity for modifying the medication regimen.  
Compare the actual therapeutic efficacy of angina drugs to the intended effect.  These data provide baseline compliance information.  
Request the patient to bring prescription medications, including the antianginal drugs, to appointments; count any remaining pills.    This method gives objective proof of compliance. This data is quite crucial in research protocols.
Examine the patient’s comprehension of his or her current condition and the significance of compliance to the treatment regimen.    Each patient has a different perspective on maintenance. Some people may avoid medical treatment because of religious convictions, while others may look into natural therapies. This method will serve as a foundation for subsequent care planning.
Examine the patient’s perspective and interest in adhering to the treatment program.  According to the Health Belief Model, a patient has perceived vulnerability to, the seriousness of, and the threat of disease and believed advantages from sticking to a medication regimen influence compliance. Some patients may be unaware of the extent of their illness or their capacity to handle some of the persistent symptoms.  
Reduce the patient’s anxiety about his illness.  Exploring the consequences of the diagnosis for the patient and offering knowledge about the illness, its treatment, and measures for averting its progression are critical nursing interventions. Furthermore, anxiety might interfere with a patient’s compliance to a treatment regimen, so it is essential to figure out how to make him feel less nervous about his health.    
Diminish the patient’s chest pain.    The nurse goes over the evaluation findings, determines the degree of the activity causing the patient’s pain, and appropriately organizes activities. The nurse must also ensure that the patient is compliant with the personalized activities.
Reduce the patient’s need for oxygen.  Balancing exercise and rest is an integral part of the patient’s and family’s educational strategy.  
Encourage the patient to express emotions and fears.  Inform the patient or family that these are normal reactions. Feelings that go unspoken can cause emotional anguish and impact one’s self-image. Concerns can be expressed verbally, decreasing stress, confirming the degree of coping, and improving dealing with sentiments. The presence of negative self-talk might enhance anxiety and lead to exacerbating angina attacks. Thus, since anxiety can impair patient compliance, this intervention will assist the patient in overcoming his worries.  
Inform the patient about the dangers of a sedentary lifestyle.  This intervention aims to educate the patient about the risk factors for sedentary lifestyles, which may include a lack of discipline or awareness of specific exercise needs, security concerns, and fear of cardiac injury.  
10. Examine symptoms of patients reported to the doctor, such as a rise in attack incidents and changes in reaction to treatments.  Patients with unstable angina may have a higher chance of surviving. Knowing what to expect can help avoid being overly concerned for trivial reasons or delaying treatment of severe symptoms. Aside from that, this method may reveal whether or not the patient is adhering to the prescription regimen.  

Noncompliance Nursing Care Plan 4

Hypertension

Nursing Diagnosis: Hypertension related to the therapeutic regimen’s adverse effects secondary to noncompliance as evidenced by the occurrence of severe complications.

Desired Outcome: The patient will be able to comprehend the disease process and its therapy, and complications will be avoided.

Noncompliance Nursing InterventionsRationale
Make a pattern diagram of hospitalizations and clinic appointments.  These data contain unbiased information about follow-up, but they do not always imply that the patient is not adhering to other prescribed therapies.    
Analyze the patient’s understanding of the hypertension treatment regimen.  Acknowledging and taking into account each patient’s concerns and misunderstandings regarding the treatment plan enhance future intervention strategies.  
Assist the patient in developing and complying with a suitable exercise routine.      This intervention helps the patient to manage hypertension with a suitable exercise routine. It is also beneficial for patients since this approach will determine how to manage hypertension.
Check if the patient checks his vital signs frequently, focusing on blood pressure and pulses, and record them.  Blood pressure and pulse rate are reliable measures of cardiac volume and output. Reduced cardiac output and blood pressure abnormalities may also signal hypertension problems. That is why this intervention is required to determine whether the patient is adhering to adequate high blood pressure management and prevention.  
Include the patient in the process of determining the best course of treatment for him or her.    Patients involved in the planning have a higher stake in the result.
Provide brief and easy-to-understand antihypertensive therapy.    Remove all unnecessary medications. When therapy is brief and straightforward, it becomes easier for the patient to comply with the treatment regimen.
Educate the patient on the use of hypertensive drugs.  Patients are frequently noncompliant with their prescribed regimen, resulting in exacerbations or deterioration of their health conditions. Therefore, provide a comprehensive list of medications and ask the patient if they have any questions about their medication, such as frequency, cost, or adverse effects.    
Simplify complex medical care.    Taking various drugs several times per day and painful injections or other time-consuming procedures increases the probability of noncompliance. To improve adherence, modify regimens or enlist the help of a home health care organization to provide care.

Noncompliance Nursing Care Plan 5

Rheumatic Fever

Nursing Diagnosis: Noncompliance related to the financial or mental burden of ongoing therapy for the rest of one’s life secondary to rheumatic fever as evidenced by refusal to comply with therapy recommendations, the appearance of comorbidities, and the exacerbation of symptoms.

Desired Outcome: The patient will comply with prescribed therapy and prevent the emergence of severe complications.

Noncompliance Nursing InterventionsRationale
Examine any relevant issues about the condition that may compromise success with the following program.  The identification of causative causes of rheumatic fever directs future intervention. This approach can be everything from financial restraints to physical limitations.  
Educate the patient about the advantages of adhering to the specified rheumatic fever treatment regimen.  Increasing awareness about the condition and its treatment enhances patients’ compliance.  
Provide pain relief and comfort.  Position the patient to lessen aches and pains; warm baths and gentle range-of-motion exercises help mitigate some joint discomfort; utilize pain indicator scales with patients to indicate the degree of suffering they are experiencing.  
Diverse activities and sensory stimulation should be provided.  Bed rest can cause discomfort or frustration in those who are not seriously ill; be interested in making diversional activities that allow bed rest but prevent uneasiness and boredom, such as a good book; quiet games can provide some entertainment, and plan all activities with the child’s developmental phase in mind.  
Simplify the routine. Suggestions for long-acting rheumatic fever drugs should be made, and needless medication should be avoided.  The more frequently patients are required to take prescriptions during the day, the greater the chance of noncompliance.    
Evaluate and monitor vital signs    Determine the effectiveness of interventions by establishing a baseline. A primary symptom is a fever. Fever or cardiac involvement can cause an increase in blood pressure and heart rate.
Step by step, introduce complex antirheumatic fever therapy to the patient.  This intervention allows the patient to know more about the treatment of rheumatic fever.    
Maintain continuity of care for patients suffering from rheumatic fever.    If follow-up visits are planned prior to discharge, patients are more likely to complete them. The usage of inpatient pharmacies that deliver to the patient’s room before discharge prevents them from forgetting to pick up a new drug at their pharmacy.
Perform a thorough physical examination on a rheumatic fever patient.  This intervention establishes a baseline. Take note of any skin irritation or rash, joint pain or swelling, or the appearance of subcutaneous lumps.    
Reduce unnecessary healthcare consultations.  The physical demands of driving to an appointment, the financial costs paid, and the bad feelings of being talked down to by health care personnel can all lead to patients avoiding necessary follow-ups. Thus, unnecessary consultation should be avoided for a time to avoid the patient’s noncompliance with the prescribed treatment plan.    
Instruct the patient to contact the health care provider once they have an upper respiratory infection, a fever, joint pain, or are not adhering to antibiotic medication.    It could mean that the disease has recurred or that the patient needs to replace or adjust the medication. As a result, it is critical to tell a healthcare practitioner as soon as difficulties emerge to avoid them from becoming severe.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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