John is a 62 y/o attorney presents to the clinic with complaints of erectile dysfunction. For the past two years, he has refused lab work. He is a heavy smoker and has not had chest X-ray or ECG in the last 3 years. He takes HCTZ 25 mg po daily. His BMI is BMI 29 and the vital signs are normal. He has agreed take Prevnar vaccine.
In this case, the main goal is to identify the barriers that cause noncompliance and risky healthy lifestyle. The first step when dealing with this patient is to establish a therapeutic alliance. This will help assess patient factors that could be triggering non-adherence. Through this interactive discussion, I asked John why he refused lab work for the past two years. He hesitated, and then he said that he cannot afford them. He said that he has always wanted to tell the healthcare provider but always feels embarrassed. The patient stated that if he could afford them he would take them as requested.
The nursing diagnosis for this patient is noncompliance related to challenges to access financial support as evidenced by the patient verbal statements that he cannot afford the procedures. In this context, I notified the hospital social worker to help the patient set for medication financial assistance. In addition, I discussed with the patient on the importance of taking these laboratory tests in improving his health, and in identifying underlying issue that is causing his erectile dysfunction (Kleinsinger, 2011).
It is important to empower patients with enough information regarding their health condition and the treatment recommendation and in a format that format that is clear to understand. Although the patient has the right to refuse treatment, the healthcare provider must inform them on the risks associated with refusal of care. Most providers will dismiss habitual non compliant patient because it increases risks for professional liability exposure.
However, in my opinion it is important to assess the patients the underlying factors. To defuse the negative emotions associated with shame and sense of failure by non compliant patient, the healthcare provider should provide non-accusatory and problem solving stances (Kleinsinger, 2011).
Kleinsinger, F. (2011). Working with the Noncompliant Patient. The Permanente Journal, 14(1), 54–60.
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